Sex Differences in Vasopressor De-escalation With Arginine Vasopressin in Mixed Cardiogenic-Vasodilatory Shock Under VA-ECMO
Abstract
BACKGROUNDS: Women with cardiogenic shock (CS) under VA-ECMO face excess mortality, yet the pharmacological basis of this disparity remains poorly understood. Arginine vasopressin (AVP) is increasingly used as a non-adrenergic vasopressor in this setting, but whether sex modifies the hemodynamic response to AVP is unknown. METHODS: In this multicenter retrospective cohort of VA-ECMO-supported CS patients, we assessed whether sex was independently associated with successful vasopressor de-escalation at 48 hours (norepinephrine equivalent dose [NEE] <0.25 µg/kg/min) after AVP initiation. Multivariable logistic regression and linear mixed-effects models were used to evaluate sex differences in treatment response and NEE trajectories over time. RESULTS: Among 193 eligible patients, 32% of women achieved successful de-escalation versus 49% of men (p = 0.023). Male sex was independently associated with treatment success (aOR 2.08, 95% CI 1.07-4.15, p = 0.033). A significant sex-by-time interaction was observed in NEE trajectories (p = 0.041), with divergence emerging at 48 hours (NEE 0.24 vs. 0.01 µg/kg/min, p = 0.008). The excess failure risk was confined to postmenopausal women aged ≥55 years (aOR 2.75, 95% CI 1.32-5.93, p = 0.008). CONCLUSION: Female sex, particularly in a postmenopausal context, was independently associated with impaired vasopressor de-escalation following AVP in CS on VA-ECMO. These hypothesis-generating findings suggest that hormonal status may modulate vascular responsiveness to AVP and support the need for prospective studies incorporating hormonal profiling.
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BibTeX
@article{beyls2026differences,
title = {{Sex Differences in Vasopressor De-escalation With Arginine Vasopressin in Mixed Cardiogenic-Vasodilatory Shock Under VA-ECMO}},
author = {Christophe Beyls and Louis Gibert and Anna Urbanc and Rebiha Boughanemed and Bélaïd Bouhemad and Yazine Mahjoub and Emmanuel Besnier and Osama Abou-Arab and Pierre-Grégoire Guinot},
journal = {Anaesthesia Critical Care \& Pain Medicine},
year = {2026},
month = oct,
doi = {10.1016/j.accpm.2026.101949},
url = {https://u-picardie.hal.science/hal-05801546v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Sex Differences in Vasopressor De-escalation With Arginine Vasopressin in Mixed Cardiogenic-Vasodilatory Shock Under VA-ECMO
AU - Christophe Beyls
AU - Louis Gibert
AU - Anna Urbanc
AU - Rebiha Boughanemed
AU - Bélaïd Bouhemad
AU - Yazine Mahjoub
AU - Emmanuel Besnier
AU - Osama Abou-Arab
AU - Pierre-Grégoire Guinot
PY - 2026
DA - 2026/10/15
JO - Anaesthesia Critical Care & Pain Medicine
DO - 10.1016/j.accpm.2026.101949
UR - https://u-picardie.hal.science/hal-05801546v1
AB - BACKGROUNDS: Women with cardiogenic shock (CS) under VA-ECMO face excess mortality, yet the pharmacological basis of this disparity remains poorly understood. Arginine vasopressin (AVP) is increasingly used as a non-adrenergic vasopressor in this setting, but whether sex modifies the hemodynamic response to AVP is unknown. METHODS: In this multicenter retrospective cohort of VA-ECMO-supported CS patients, we assessed whether sex was independently associated with successful vasopressor de-escalation at 48 hours (norepinephrine equivalent dose [NEE] <0.25 µg/kg/min) after AVP initiation. Multivariable logistic regression and linear mixed-effects models were used to evaluate sex differences in treatment response and NEE trajectories over time. RESULTS: Among 193 eligible patients, 32% of women achieved successful de-escalation versus 49% of men (p = 0.023). Male sex was independently associated with treatment success (aOR 2.08, 95% CI 1.07-4.15, p = 0.033). A significant sex-by-time interaction was observed in NEE trajectories (p = 0.041), with divergence emerging at 48 hours (NEE 0.24 vs. 0.01 µg/kg/min, p = 0.008). The excess failure risk was confined to postmenopausal women aged ≥55 years (aOR 2.75, 95% CI 1.32-5.93, p = 0.008). CONCLUSION: Female sex, particularly in a postmenopausal context, was independently associated with impaired vasopressor de-escalation following AVP in CS on VA-ECMO. These hypothesis-generating findings suggest that hormonal status may modulate vascular responsiveness to AVP and support the need for prospective studies incorporating hormonal profiling.
SN - 2352-5568
ER -