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Sex-specific differences and outcome in elderly patients after survived out-of-hospital cardiac arrest

Geschlechtsspezifische Unterschiede und Outcome bei älteren Patienten nach überlebtem präklinischem Herzstillstand

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Abstract

Background

Little is known about sex differences in elderly patients after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) and subsequent target temperature management (TTM). Therefore, this study was designed to evaluate sex-specific differences in survival and neurological outcome in elderly patients at 28-day and 180-day follow-up.

Methods

A total of 468 nontraumatic OHCA survivors with preclinical ROSC and an age of ≥ 65 years were included in this study. Sex-specific differences in survival and a favorable neurological outcome according to the cerebral performance category (CPC) score were evaluated as clinical endpoints.

Results

Of all participants included, 70.7% were men and 29.3% women. Women were significantly older (p = 0.011) and were more likely to have a nonshockable rhythm (p = 0.001) than men. Evaluation of survival rate and favorable neurological outcome by sex category showed no significant differences at 28-day and 180-day follow-up. In multiple stepwise logistic regression analysis, age (odds ratio 0.932 [95% confidence interval 0.891–0.951], p = 0.002) and time of hypoxia (0.899 [0.850–0.951], p < 0.001) proved to be independent predictors of survival only in male patients, whereas an initial shockable rhythm (4.325 [1.309–14.291], p = 0.016) was associated with 180-day survival in female patients. The majority of patients (93.7%) remained in the same CPC category when comparing 28-day and 180-day follow-up.

Conclusion

Our results show no significant sex-specific differences in survival or favorable neurological outcome in elderly patients after having survived OHCA, but sex-specific predictors for 180-day survival. Moreover, the neurological assessment 28 days after the index event also seems to provide a valid indication for the further prognosis in elderly patients.

Zusammenfassung

Hintergrund

Aktuell existieren nur wenige Daten über geschlechtsspezifische Unterschiede bei älteren Patienten mit überlebtem außerklinischem Herz-Kreislauf-Stillstand (OHCA) und anschließendem Temperaturmanagement (TTM). Daher wurden geschlechtsspezifische Unterschiede im Überleben und im neurologischen Ergebnis bei älteren Patienten nach 28 und 180 Tagen untersucht.

Material und Methoden

Insgesamt wurden 468 Patienten ≥ 65 Jahren mit OHCA sowie präklinischer Rückkehr eines Spontankreislaufs (ROSC) berücksichtigt. Evaluiert wurden die Überlebenswahrscheinlichkeit und der neurologischer Status gemessen mittels Cerebral-Performance-Category(CPC)-Skala.

Ergebnisse

Frauen (29,3 % des Studienkollektivs) waren im Vergleich zu Männern (70,7 %) signifikant älter (p = 0,011) und wiesen häufiger einen nicht schockbaren Rhythmus (p = 0,001) auf. Es wurden kein signifikanter Unterschied beim Überleben und beim neurologischen Outcome festgestellt. In der multiplen Regressionsanalyse wurden bei männlichen Patienten das Alter (Odds-Ratio 0,932 [95 %-Konfidenzintervall 0,891–0,951], p = 0,002) und die Zeit bis zum Beginn der Reanimation (0,899 [0,850–0,951], p < 0,001) als unabhängige Prädiktoren für das Überleben nach 6 Monaten identifiziert. Bei Frauen zeigte nur ein initial schockbarer Rhythmus (4,325 [1,309–14,291], p = 0,016) eine unabhängige Assoziation mit dem Überleben nach 6 Monaten. Die Mehrheit der Patienten (93,7 %) wies keine Änderung des neurologischen Status zwischen den Messzeitpunkten auf.

Diskussion

Die Ergebnisse zeigen bei älteren Patienten bis 6 Monate nach dem Herz-Kreislauf-Stillstand keinen geschlechtsspezifischen Unterschied beim Überleben und beim neurologischen Status, aber geschlechtsspezifische Prädiktoren für das 180-Tage-Überleben. Zudem war eine valide prognostische Aussage bezüglich des neurologischen Status bereits 28 Tage nach dem Indexereignis möglich.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Toni Pätz MD, Thomas Stiermaier & Ingo Eitel

  2. Emergency Department, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Katharina Stelzig & Sebastian Wolfrum

  3. Clinic for Internal Medicine, University of Jena, Am Klinikum 1, 07747, Jena, Germany

    Rüdiger Pfeifer

  4. Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany

    Holger Thiele

  5. University Emergency Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany

    Hans-Jörg Busch

Authors
  1. Toni Pätz MD
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  2. Katharina Stelzig
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  3. Rüdiger Pfeifer
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Corresponding author

Correspondence to Toni Pätz MD.

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Conflict of interest

T. Pätz, K. Stelzig, R. Pfeifer, H. Thiele, H.-J. Busch, T. Stiermaier, I. Eitel and S. Wolfrum declare that they have no competing interests.

Anonymized data were transmitted into the registry with approval by the local ethic committees.

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Pätz, T., Stelzig, K., Pfeifer, R. et al. Sex-specific differences and outcome in elderly patients after survived out-of-hospital cardiac arrest. Med Klin Intensivmed Notfmed 117, 630–638 (2022). https://doi.org/10.1007/s00063-021-00869-2

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  • DOI: https://doi.org/10.1007/s00063-021-00869-2

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