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Meta-Analysis
. 2020 Oct 19;24(1):613.
doi: 10.1186/s13054-020-03331-5.

Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Hao Lei  1 , Jiahui Hu  1 , Leiling Liu  1 , Danyan Xu  2
Affiliations
Meta-Analysis

Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Hao Lei et al. Crit Care. .

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. However, conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after OHCA. Therefore, we investigated the relationship between the prognosis of OHCA and sex factors.

Methods: We comprehensively searched the PubMed, Embase, and Cochrane databases and obtained a total of 1042 articles, from which 33 studies were selected for inclusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.

Results: The meta-analysis included 1,268,664 patients. Compared with males, females were older (69.7 years vs. 65.4 years, p < 0.05) and more frequently suffered OHCA without witnesses (58.39% vs 62.70%, p < 0.05). Females were less likely to receive in-hospital interventions than males. There was no significant difference between females and males in the survival from OHCA to hospital admission (OR 0.99, 95% CI 0.89-1.1). However, females had lower chances for survival from hospital admission to discharge (OR 0.59, 95% CI 0.48-0.73), overall survival to hospital discharge (OR 0.73, 95% CI 0.62-0.86), and favorable neurological outcomes (OR 0.62, 95% CI 0.47-0.83) compared with males.

Conclusions: Our results indicate that the overall discharge survival rate of females is lower than that of males, and females face a poor prognosis of the nervous system. This is likely related to the pathophysiological characteristics of females, more conservative treatment measures compared with males, and different post-resuscitation care. However, these findings should be interpreted with caution due to the presence of several confounding factors.

Keywords: Out-of-hospital cardiac arrest; Post-resuscitation care; Prognosis; Sex; Survival.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The process of study selection
Fig. 2
Fig. 2
Forest plot and meta-analysis of the sex differences in survival from OHCA to admission
Fig. 3
Fig. 3
Forest plot and meta-analysis of the sex differences in survival from admission to discharge
Fig. 4
Fig. 4
Forest plot and meta-analysis of the sex differences in survival from OHCA to discharge
Fig. 5
Fig. 5
Forest plot and meta-analysis of the sex differences in neurological prognosis
See this image and copyright information in PMC

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