Eachempati S R, Hydo L, Barie P S
Department of Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Arch Surg. 1999 Dec;134(12):1342-7. doi: 10.1001/archsurg.134.12.1342.
Among factors postulated to affect outcome in sepsis is the gender of the patient, with a suggestion that females may have lower mortality. This study tested the hypothesis that female patients admitted to the surgical intensive care unit with a documented infection have a lower mortality rate.
Retrospective analysis of a prospectively collected data set.
Surgical intensive care unit of a university hospital medical center.
Analysis of a consecutive series of 1348 patients who had signs of systemic inflammatory response syndrome on admission to a surgical intensive care unit. A cohort of 443 patients (32.9%) admitted with documented infection--and who therefore had sepsis, severe sepsis, or septic shock--constituted the study population. For each patient, APACHE (Acute Physiology and Chronic Health Evaluation) II and III scores, systemic inflammatory response syndrome score, gender, age, and hospital mortality were recorded. Chi2 With Fisher exact test was performed to compare mortality rates between males and females. Univariate analysis of variance was used to compare continuous variables in discrete populations. Multivariate analysis of variance was used to determine which factors independently predicted mortality.
Mortality, intensive care unit length of stay, hospital length of stay, and maximal multiple organ dysfunction score. Outcomes stratified by gender.
Patients had mean +/- SEM age of 67+/-1 years; mean +/- SEM APACHE II and III scores of 20.1+/-0.4 and 67.7+/-1.0 points, respectively. There were no demographic differences between genders. Overall, 104 (23.5%) of 443 patients with sepsis died. The difference in mortality rates between female and male patients was not significant, except in octogenarians (P = .05). Multivariate analysis of variance, APACHE III (P<.001), maximal multiple organ dysfunction score (P<.001), and female gender (P =.02) predicted mortality. In females, APACHE III (P = .03) and maximal multiple organ dysfunction score (P<.001) predicted mortality, but age did not.
Female gender is an independent predictor of increased mortality in critically ill surgical patients with documented infection.
在假定影响脓毒症预后的因素中，患者性别是其中之一，有观点认为女性的死亡率可能较低。本研究检验了这一假说，即入住外科重症监护病房且有感染记录的女性患者死亡率较低。
对前瞻性收集的数据集进行回顾性分析。
大学医院医疗中心的外科重症监护病房。
分析连续1348例入住外科重症监护病房时出现全身炎症反应综合征体征的患者。443例（32.9%）有感染记录——因此患有脓毒症、严重脓毒症或脓毒性休克——的患者组成研究人群。记录每名患者的急性生理与慢性健康状况评分（APACHE）II和III、全身炎症反应综合征评分、性别、年龄和医院死亡率。采用卡方检验和Fisher精确检验比较男性和女性的死亡率。单因素方差分析用于比较不同人群中的连续变量。多因素方差分析用于确定哪些因素能独立预测死亡率。
死亡率、重症监护病房住院时间、医院住院时间和最大多器官功能障碍评分。按性别分层的结果。
患者的平均年龄（±标准误）为67±一岁；APACHE II和III评分的平均值（±标准误）分别为20.1±0.4和67.7±1.0分。性别之间在人口统计学上无差异。总体而言，443例脓毒症患者中有104例（23.5%）死亡。女性和男性患者的死亡率差异不显著，除了八旬老人（P = 0.05）。多因素方差分析显示，APACHE III（P<0.001）、最大多器官功能障碍评分（P<0.001）和女性性别（P = 0.02）可预测死亡率。在女性中，APACHE III（P = 0.03）和最大多器官功能障碍评分（P<0.001）可预测死亡率，但年龄不能。
对于有感染记录的重症外科患者，女性性别是死亡率增加的独立预测因素。
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