Abstract 141: Associations Between Sex Steroids And Cardiac Arrest Outcomes

Abstract

Introduction: Sudden cardiac arrest (SCA) is one of the leading causes of death in both males and females although females tend to have better outcomes. While sex steroids influence cardiovascular disease, and low level of testosterone and high level of estradiol is associated with the risk of SCA, little is known about their changes after a cardiac arrest, and their association to outcomes. We sought to characterize the temporal trajectories in sex steroids (estrogens [estrone and estradiol], progesterone, and testosterone) in the post-return of spontaneous circulation (ROSC) phase and determine associations with survival and neurological outcomes. Hypothesis: Sex steroids and their temporal trajectories post-SCA are associated with survival and neurological outcomes. Methods: Plasma samples from SCA patients (n=65, 74% males) were collected at the University of Texas Houston between May 2018-March 2020 at four serial time points (0, 6, 24, 48h) post-ROSC. Quantitative sex hormone analysis was performed using LCMS. Data was analyzed by t-test, Chi 2 test and Generalized Estimating Equation (GEE) with p<0.05 indicating significance. Results: There were no differences in demographic and clinical characteristics between males and females. Plasma estrogens peaked at 24 hours, whereas progesterone and testosterone peaked at 6 hours. Estrogens and testosterone were higher in males, while progesterone trended higher in females. Hormonal trajectories did not differ by survival, however, testosterone concentrations were lower in patients with good neurological recovery. Lower estradiol was associated with survival (β: -13.80, p=0.016) adjusting for sex, time, and age, while a lower testosterone was associated with good neurological recovery (β: -0.68, p=0.031) adjusting for time. Conclusion: Increased circulating sex steroid concentrations were observed in the post-ROSC phase after SCA. High levels of estrogens were associated with worse survival independent of sex, and lower testosterone levels were associated with better neurological recovery. A larger sample size and simultaneous measurement of cortisol will be important to better understand the role of sex hormones in outcomes after SCA.