Abstract P102: Sex Differences in Laboratory Values Prior to In-Hospital Cardiac Arrest

Abstract

Introduction: In-hospital cardiac arrest (IHCA) is a major public health problem. Before the pandemic, around 292,000 cases were treated yearly in the United States. It is associated with a significant morbidity and mortality, <25% survival rate to hospital discharge. The effectiveness of prediction methods and established therapies in preventing IHCA remains debatable. Limited sex difference studies for evaluating therapies have led to healthcare inequities, with women faring worse. Laboratory (lab) values that guide and evaluate the efficiency of therapies in hospitalized patients are not fully explored with respect to sex differences. Hypothesis: There is a statistically significant difference in the serum electrolytes, estimated glomerular filtration rate; uncorrected ionized calcium and lactate from arterial blood gas between females and males within 72 hours of IHCA. Methods: A retrospective study was conducted in a single academic medical center using electronic health records of adult patients (≥18 years old) with a history of cardiopulmonary diseases who experienced IHCA (n=98) in acute care or an intensive care unit (2014-2016). Only the first episode of IHCA was recorded during the period of hospitalization. Patients were excluded if the IHCA was due to trauma, terminal cancer, and human immunodeficiency virus infection or if patients were comatose. Lab values were analyzed with respect to hours and days prior to IHCA. Linear mixed effect models (p<0.05) were used to examine the sex differences in lab values within 72 hours/3 days of IHCA and were adjusted by age and ejection fraction using the Tukey-Kramer procedure. Day 0= 0-23 hours, Day 1= 24-47 hours, and Day 2=48-72 hours. Results: The sample’s characteristics included: age (69±15), sex (female 33%,), location (intensive care units 54%), the initial rhythm of cardiac arrest (ventricular tachycardia, ventricular fibrillation 28%), ejection fraction (44±20), history of coronary artery diseases (78%,), pulmonary diseases (29%), unsuccessful return of spontaneous circulation (38%), and survival to hospital discharge (22%). Unadjusted statistical significance within 72 hours of IHCA was found in sodium and chloride (p<0.0047, p<0.001). Statistical significance was found when adjusted by age and ejection fraction in sodium, potassium, and chloride (p<0.04, p<0.001, p<0.00). Significant statistical sex differences were found after adjusting for age and ejection fraction in potassium and lactate when comparing day 0 with day 1 and day 2 (p<0.03, p<0.001). Conclusions: Quantifying lab values concerning sex differences will tailor therapeutic therapies to biological differences and will guide the areas of improvements in patient outcomes.