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Sex differences in neurological outcomes for patients with In-Hospital cardiac arrest
Hai Wang1, Longfei Li1, Shiyao Li1
1Emergency department, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, Shaanxi Province, China.
Background:
Sex differences in cardiac arrest outcomes had been widely studied in out-of-hospital cardiac arrest (OHCA). However, limited research has explored the impact of sex on neurological outcomes of patients with in-hospital cardiac arrest (IHCA).
Objective:
This study aimed to investigate the association between sex and neurological outcomes at hospital discharge in IHCA patients.
Methods:
A retrospective cohort study analyzed 1,536 adult IHCA patients from National Taiwan University Hospital. Neurological outcomes were categorized as favorable (CPC 1-2) or poor (CPC 3-5). Propensity score matching and logistic regression adjusted for confounders, with sensitivity and subgroup analyses validating results.
Results:
The female had significantly poorer neurological outcomes compared to the male (95.34% vs. 90.80%, P < 0.001). Female sex was independently associated with poor neurological outcomes across multiple analytical approaches. In the unadjusted analysis, female patients demonstrated significantly higher odds of poor neurological outcomes (OR = 2.07, 95%CI: 1.34-3.22, P = 0.001). This association persisted after adjusting for clinical variables (Model 1: OR = 2.38, 95%CI: 1.40-4.03, P = 0.001) and propensity scores (Model 2: OR = 2.38, 95%CI: 1.39-4.01, P < 0.001). In the propensity score-matched cohort (n = 1,180), the association strengthened, with the fully adjusted model showing the robust relationship (Model 3: OR = 2.77, 95%CI: 1.54-4.99, P < 0.002). Sensitivity and subgroup analyses consistently supported these findings.
Conclusion:
Female was independently associated with poor neurological outcomes in IHCA patients. The findings highlighted the need for further research to explore underlying mechanisms and develop sex-specific strategies to improve IHCA outcomes.
