Effect of sex on the association between arterial partial pressure of oxygen and in-hospital mortality in ICU patients with cardiogenic shock: a retrospective cohort study

Ning Zhao; Zelin Pan; Qilin Yang; Juanmei Chen; Dongxue Ruan; Meiqi Huang; Peilin Lu; Xumin Chen; Xinqiao Huang; Xiaozhen Lin; Pei Mo

doi:10.21037/atm-22-5141

Effect of sex on the association between arterial partial pressure of oxygen and in-hospital mortality in ICU patients with cardiogenic shock: a retrospective cohort study

Ann Transl Med. 2022 Dec;10(24):1313. doi: 10.21037/atm-22-5141.

Authors

Ning Zhao^#¹, Zelin Pan^#², Qilin Yang², Juanmei Chen³, Dongxue Ruan³, Meiqi Huang³, Peilin Lu³, Xumin Chen³, Xinqiao Huang³, Xiaozhen Lin¹, Pei Mo¹

Affiliations

¹ Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³ The Second Clinical College, Guangzhou Medical University, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Maintaining tissue perfusion and oxygen supply are essential for cardiogenic shock (CS) treatment. Sex has been reported to be associated with mortality and oxygen use in patients with CS. Males and females respond differently to hypoxia. We designed this cohort study to evaluate the effects of sex on the association between the arterial partial pressure of oxygen (PaO₂) and in-hospital mortality.

Methods: We used the Medical Information Mart for Intensive Care (MIMIC) IV database for this cohort study. The outcome was in-hospital mortality. The relationship between the PaO₂ and in-hospital mortality was compared with sex (via an interaction test) using multivariable Cox regression models. Presence of interaction between PaO₂ and sex was tested by using inter interaction terms.

Results: A total of 1,772 patients with CS were enrolled in this study. The association between PaO₂ and in-hospital mortality appeared to differ between males and females [hazard ratio (HR): 0.997, 95% confidence interval (CI): 0.995-0.999 vs. HR: 1.002, 95% CI: 0.999-1.003, P for interaction =0.002]. We repeated the analyses, based on different PaO₂ category (PaO₂ <60 mmHg; PaO₂ 60-100 mmHg; PaO₂ >100 mmHg) and the results remained stable, P for interaction =0.008.

Conclusions: Sex affects the relationship between PaO₂ and in-hospital mortality in CS patients. Our findings may lead to the development of individualized therapies that focus on the use of different target oxygen partial pressures in different sexes to treat patients with CS.

Keywords: Sex; arterial partial pressure of oxygen; cardiogenic shock (CS); in-hospital mortality.