병원 밖 심정지 후 자발순환이 회복된 환자에서의 예후인자: 후향적인 코호트 연구 = Men Associated with Good Prognosis after Return of Spontaneous Circulation after Out-of Hospital Cardiac Arrest: a Retrospective Study in One Emergency Center

다국어 초록 (Multilingual Abstract)

Background: The aim of this study was to analyze the gender factors associated with good or bad prognosis after return of spontaneous circulation after out-of hospital cardiac arrest.
Methods: The patients admitted to the intensive care unit after successful resuscitation after out-of hospital cardiac arrest were retrospectively identified and evaluated. Thirty days mortality after admission, and neurologic outcome at 6 months after hospital discharge (cerebral performance category [CPC]) were evaluated.
Results: One hundred forty-two patients were evaluated in this study; there were 101 males (71.1%). The median age was 52 years old (43－63). Thirty days after admission, 85 patients (59.9%) survived, 40 patients had a good neurologic outcome (CPC 1－2). The factors associated 30 days mortality were cause of arrest (non-cardiac, p = 0.03), lactate in emergency department (p = 0.05) and the factors associated with good neurologic outcome were males (p = 0.007), young age (p = 0.01), body weight and height (p = 0.001), cause of death (cardiac, p = 0.000). Alcohols and smoking were not associated with mortality and neurologic outcome. In multiple logistic regression analysis, men had a 8-fold increased good neurologic outcome (CPC 1－2) (odds ratio [OR] 8.038, 95% Confidence Interval [CI] 1.079-59.903). Other factors associated with good neurologic outcome were cardiac cause of death (OR 5.523, 95% CI 1.562－19.533) and young age (OR 1.055, 95% CI 1.009－1.103).
Conclusions: Men had a good neurologic outcome after return of spontaneous circulation after out-of hospital cardiac arrest in one emergency center. Other additional factors including gonadal hormones should be evaluated.

참고문헌 (Reference)

1 Perers E, "There is a difference in characteristics and outcome between women and men who suffer out of hospital cardiac arrest" 40 : 133-140, 1999

2 Federman DD, "The biology of human sex differences" 354 : 1507-1514, 2006

3 Kannel WB, "Sudden death: lessons from subsets in population studies" 5 (5): 141B-149B, 1985

4 Wigginton JG, "Sex-related differences in the presentation and outcome of out-of-hospital cardiopulmonary arrest: a multiyear, prospective, population-based study" 30 (30): S131-S136, 2002

5 Tunstall-Pedoe H, "Sex differences in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991. Presentation, diagnosis, treatment, and 28-day case fatality of 3991 events in men and 1551 events in women" 93 : 1981-1992, 1996

6 Hallstrom AP, "Predictors of hospital mortality after out-of-hospital cardiopulmonary resuscitation" 13 : 927-929, 1985

7 Weston CF, "Predicting survival from out-of-hospital cardiac arrest: a multivariate analysis" 34 : 27-34, 1997

8 Adrie C, "OutcomeRea Study Group: Influence of gender on the outcome of severe sepsis: a reappraisal" 132 : 1786-1793, 2007

9 Kim C, "Out-of- hospital cardiac arrest in men and women" 104 : 2699-2703, 2001

10 Alkayed NJ, "Neuroprotective effects of female gonadal steroids in reproductively senescent female rats" 31 : 161-168, 2000

11 Hubacek JA, "Gene variants of the bactericidal/permeability increasing protein and lipopolysaccharide binding protein in sepsis patients: gender-specific genetic predisposition to sepsis" 29 : 557-561, 2001

12 Nachtigall I, "Gender-related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study" 15 : R151-, 2011

13 Valentin A, "Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients" 31 : 1901-1907, 2003

14 Eachempati SR, "Gender-based differences in outcome in patients with sepsis" 134 : 1342-1347, 1999

15 Combes A, "Gender impact on the outcomes of critically ill patients with nosocomial infections" 37 : 2506-2511, 2009

16 Jover T, "Estrogen protects against global ischemia-induced neuronal death and prevents activation of apoptotic signaling cascades in the hippocampal CA1" 22 : 2115-2124, 2002

17 Ahn KO, "Epidemiology and outcomes from non-traumatic out-of- hospital cardiac arrest in Korea: A nationwide observational study" 81 : 974-981, 2010

18 Ishrat T, "Effects of progesterone administration on infarct volume and functional deficits following permanent focal cerebral ischemia in rats" 1257 : 94-101, 2009

19 Topjian AA, "American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators: Women of child-bearing age have better inhospital cardiac arrest survival outcomes than do equal-aged men" 38 : 1254-1260, 2010

20 Le Gall JR, "A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study" 270 : 2957-2963, 1993