Division of Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY.
Center for Innovation and Outcome Research, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY.
J Thorac Cardiovasc Surg. 2022 Sep;164(3):960-969.e6. doi: 10.1016/j.jtcvs.2020.12.044. Epub 2020 Dec 23.
Our study assesses differences between male and female patients placed on venoarterial extracorporeal membrane oxygenation for cardiogenic shock.
We retrospectively analyzed 574 adult patients placed on venoarterial extracorporeal membrane oxygenation for cardiogenic shock at our institution between January 2007 and December 2018. Baseline characteristics and outcomes were assessed. Propensity score matching was used to compare outcomes. The primary end point was in-hospital mortality. Secondary outcomes include limb ischemia, limb ischemia interventions, distal perfusion cannula placement, stroke, bleeding, and continuous venovenous hemofiltration initiation.
There were 394 male patients (69%) and 180 female patients (31%). After adjusting for baseline differences, propensity score matching compared 171 male patients with 171 female patients. No difference was seen between men and women in in-hospital mortality (60.2% vs 56.7%; P = .59), limb ischemia (47.4% vs 45.6%; P = .83), limb ischemia surgery (15.2% vs 12.9%; P = .64), bleeding (49.7% vs 49.1%; P = 1), continuous venovenous hemofiltration initiation (39.2% vs 32.7%; P = .26), and stroke (8.2% vs 9.4%; P = .85). Multivariable logistic regression showed that female patients who died were more likely to have had chronic kidney disease (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.09-6.53; P = .032) than surviving women. Male patients who died were more likely to have had coronary artery disease (OR, 2.25; 95% CI, 1.34-3.78; P = .002) and higher lactate levels (OR, 1.14; 95% CI, 1.08-1.21; P < .001) than surviving men. Women with cardiac transplant primary graft dysfunction were more likely to survive (OR, 0.04; 95% CI, 0.01-0.27; P = .001), whereas men with cardiac transplant primary graft dysfunction were less likely to survive (OR, 0.28; 95% CI, 0.11-0.71; P = .007), than patients with other shock etiologies.
After adjusting for baseline difference, there was no difference in outcomes between male and female patients despite differing risk profiles for in-hospital mortality.
我们的研究评估了因心原性休克接受静脉-动脉体外膜肺氧合治疗的男性和女性患者之间的差异。
我们回顾性分析了 2007 年 1 月至 2018 年 12 月期间在我院因心原性休克接受静脉-动脉体外膜肺氧合治疗的 574 例成年患者。评估了基线特征和结局。使用倾向评分匹配来比较结局。主要终点是院内死亡率。次要结局包括肢体缺血、肢体缺血干预、远端灌注插管放置、卒中和出血以及连续静脉-静脉血液滤过的启动。
有 394 例男性患者（69%）和 180 例女性患者（31%）。调整基线差异后，倾向评分匹配比较了 171 例男性患者和 171 例女性患者。男性和女性在院内死亡率（60.2% vs 56.7%；P=0.59）、肢体缺血（47.4% vs 45.6%；P=0.83）、肢体缺血手术（15.2% vs 12.9%；P=0.64）、出血（49.7% vs 49.1%；P=1）、连续静脉-静脉血液滤过的启动（39.2% vs 32.7%；P=0.26）和卒中等方面均无差异（8.2% vs 9.4%；P=0.85）。多变量逻辑回归显示，死亡的女性患者更有可能患有慢性肾脏病（比值比[OR]，2.67；95%置信区间[CI]，1.09-6.53；P=0.032），而存活的女性患者则不然。死亡的男性患者更有可能患有冠状动脉疾病（OR，2.25；95%CI，1.34-3.78；P=0.002）和更高的血乳酸水平（OR，1.14；95%CI，1.08-1.21；P<0.001），而存活的男性患者则不然。心脏移植原发性移植物功能障碍的女性患者更有可能存活（OR，0.04；95%CI，0.01-0.27；P=0.001），而心脏移植原发性移植物功能障碍的男性患者则不太可能存活（OR，0.28；95%CI，0.11-0.71；P=0.007），而患有其他休克病因的患者则不然。
尽管院内死亡率的风险状况不同，但在调整了基线差异后，男性和女性患者的结局没有差异。
