急诊医疗团队描述的肥胖与院外心脏骤停患者结局之间关联的性别差异。

Sex-related differences in the association of obesity described by emergency medical teams on outcomes in out-of-hospital cardiac arrest patients.

作者信息

Briz Vicente Doménech, Juárez-Vela Raúl, Lewandowski Łukasz, Kubielas Grzegorz, Smereka Jacek, Gea-Caballero Vicente, Martínez-Sabater Antonio, Czapla Michał

机构信息

Epidemiology Unit, Xativa Public Health Center, Valencia, Spain.

Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logrońo, Spain.

出版信息

Adv Clin Exp Med. 2024 Nov 7. doi: 10.17219/acem/193367.

DOI:10.17219/acem/193367

PMID:39508211

Abstract

BACKGROUND

Out-of-hospital cardiac arrests (OHCA) are a major global health concern, occurring frequently worldwide. Obesity may impact outcomes in OHCA patients.

OBJECTIVES

This study aimed to assess the impact of obesity on the return of spontaneous circulation (ROSC) in OHCA patients, considering sex differences.

MATERIAL AND METHODS

A retrospective cohort study was conducted, analyzing medical records of patients assisted by the Emergency Medical System (EMS) in Poland from January 2021 to June 2022. The study included 33,636 patients with OHCA. Obesity status was determined using ICD-10 codes (E66) and descriptive diagnoses recorded by EMS teams.

RESULTS

Univariate analysis indicated that obesity decreased the odds of ROSC by 25.47% (odds ratio (OR) = 0.75, 95% confidence interval (95% CI): 0.61-0.92) in women and by 19.76% (OR = 0.80, 95% CI: 0.66-0.97) in men. However, multivariate analysis, adjusting for confounding variables, did not confirm a statistically significant impact of obesity on ROSC outcomes. The likelihood of ROSC was significantly higher in individuals with an initial ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) rhythm compared to Asystole/pulseless electrical activity (PEA), being 4.204 times higher in women (95% CI: 3.525-5.014) and 3.655 times in men (95% CI: 3.320-4.023). Out-of-hospital cardiac arrest in a public place increased the odds of ROSC more than twofold for both sexes (women: OR = 2.20, 95% CI: 2.00-2.43; men: OR = 2.13, 95% CI: 1.98-2.29). Among women without obesity, hypertension decreased the odds of ROSC by 11.11% (OR = 0.89, 95% CI: 0.81-0.99).

CONCLUSIONS

Our study demonstrated that obesity was not an independent predictor of ROSC in OHCA patients. Different predictors of ROSC were identified for men and women. Initial VF/pVT rhythm, location of OHCA and age were the significant factors influencing ROSC.

摘要

背景

院外心脏骤停（OHCA）是一个重大的全球健康问题，在世界范围内频繁发生。肥胖可能会影响OHCA患者的预后。

目的

本研究旨在评估肥胖对OHCA患者自主循环恢复（ROSC）的影响，并考虑性别差异。

材料与方法

进行了一项回顾性队列研究，分析了2021年1月至2022年6月在波兰由紧急医疗系统（EMS）协助的患者的医疗记录。该研究纳入了33636例OHCA患者。使用ICD - 10编码（E66）和EMS团队记录的描述性诊断来确定肥胖状态。

结果

单因素分析表明，肥胖使女性ROSC的几率降低了25.47%（优势比（OR）=0.75，95%置信区间（95%CI）：0.61 - 0.92），使男性降低了19.76%（OR = 0.80，95%CI：0.66 - 0.97）。然而，在对混杂变量进行调整的多因素分析中，未证实肥胖对ROSC结果有统计学上的显著影响。与心搏停止/无脉电活动（PEA）相比，初始为心室颤动（VF）或无脉性室性心动过速（pVT）节律的个体ROSC可能性显著更高，女性高4.204倍（95%CI：3.525 - 5.014），男性高3.655倍（95%CI：3.320 - 4.023）。在公共场所发生院外心脏骤停使男女两性ROSC的几率增加两倍多（女性：OR = 2.20，95%CI：2.00 - 2.43；男性：OR = 2.13，95%CI：1.98 - 2.29）。在无肥胖的女性中，高血压使ROSC的几率降低了11.11%（OR = 0.89，95%CI：0.81 - 0.99）。