心脏骤停后重症监护病房护理及预后的性别差异：一项瑞士全国性分析。
Sex disparities in ICU care and outcomes after cardiac arrest: a Swiss nationwide analysis.
作者信息
Amacher Simon A, Zimmermann Tobias, Gebert Pimrapat, Grzonka Pascale, Berger Sebastian, Lohri Martin, Tröster Valentina, Arslani Ketina, Merdji Hamid, Gebhard Catherine, Hunziker Sabina, Sutter Raoul, Siegemund Martin, Gebhard Caroline E
机构信息
Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 5, 4031, Basel, Switzerland.
Department of Anesthesiology and Intensive Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
出版信息
Crit Care. 2025 Jan 23;29(1):42. doi: 10.1186/s13054-025-05262-5.
BACKGROUND
Conflicting data exist regarding sex-specific outcomes after cardiac arrest. This study investigates sex disparities in the provision of critical care and outcomes of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.
METHODS
Analysis of adult cardiac arrest patients admitted to certified Swiss intensive care units (ICUs) (01/2008-12/2022) using the nationwide prospective ICU registry. The primary outcome was ICU mortality, with secondary outcomes including ICU admission probability and advanced treatment provision.
RESULTS
Among 41,733 individuals (34.9% women), 21,692 patients (30.6% women) were admitted to ICUs (16,571 OHCA patients/5121 IHCA patients). Women were less likely to be admitted to the ICU than men (incidence rate ratio 0.82 [95% CI 0.80-0.85] and had a higher ICU mortality (41.8% vs 36.2%; p < 0.001). Mortality differences were more pronounced in OHCA patients (unadjusted HR: 1.35 [95% CI 1.28-1.43]; adjusted HR: 1.19 [95% CI 1.12-1.25]). In IHCA patients, mortality differences were less pronounced (unadjusted HR: 1.14 [95% CI 1.04-1.25]) and vanished after adjustment for confounders: adjusted HR: 1.03 [95% CI 0.94-1.13]). Women after cardiac arrest were older, more severely ill, and received fewer interventions before (44.7% vs 54.0%; p < 0.001) and during ICU stay. A subgroup analysis of 11,202 patients revealed that treatment limitations were more frequent in women (46.7% vs 38.7%; p < 0.001). However, these limitations were associated with an increased risk of death in both sexes.
CONCLUSIONS
This study highlights sex disparities in short-term mortality and ICU resource allocation among cardiac arrest patients, with women potentially facing disadvantages, in particular after OHCA. The limitations of ICU registry data, particularly the lack of detailed cardiac arrest-specific and comorbidity information, restrict definitive conclusions. Future research should prioritize prospective studies with more granular data to better understand and address these disparities.
背景
关于心脏骤停后特定性别的结果存在相互矛盾的数据。本研究调查了重症监护的提供以及院内心脏骤停（IHCA）和院外心脏骤停（OHCA）患者的结局方面的性别差异。
方法
使用全国性前瞻性重症监护病房（ICU）登记册对入住瑞士认证ICU的成年心脏骤停患者进行分析（2008年1月 - 2022年12月）。主要结局是ICU死亡率，次要结局包括入住ICU的概率和高级治疗的提供情况。
结果
在41,733名个体中（34.9%为女性），21,692名患者（30.6%为女性）入住了ICU（16,571名OHCA患者/5121名IHCA患者）。女性比男性更不容易入住ICU（发病率比0.82 [95%置信区间0.80 - 0.85]），且ICU死亡率更高（41.8%对36.2%；p < 0.001）。OHCA患者的死亡率差异更为明显（未调整的风险比：1.35 [95%置信区间1.28 - 1.43]；调整后的风险比：1.19 [95%置信区间1.12 - 1.25]）。在IHCA患者中，死亡率差异不太明显（未调整的风险比：1.14 [95%置信区间1.04 - 1.25]），在对混杂因素进行调整后差异消失：调整后的风险比：1.03 [95%置信区间0.94 - 1.13]）。心脏骤停后的女性年龄更大、病情更严重（44.7%对54.0%；p < 0.001），且在ICU住院前和住院期间接受的干预较少。对11,202名患者的亚组分析显示，女性的治疗限制更为常见（46.7%对38.7%；p < 0.001）。然而，这些限制与两性死亡风险的增加均相关。
结论
本研究突出了心脏骤停患者在短期死亡率和ICU资源分配方面的性别差异，女性可能面临劣势，尤其是在OHCA后。ICU登记数据的局限性，特别是缺乏详细的心脏骤停特异性和合并症信息，限制了确定性结论。未来的研究应优先进行具有更详细数据的前瞻性研究，以更好地理解和解决这些差异。
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