创伤后呼吸机相关性肺炎的性别差异：确定死亡率的危险因素。
Gender disparity in ventilator-associated pneumonia following trauma: identifying risk factors for mortality.
机构信息
From the Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
出版信息
J Trauma Acute Care Surg. 2014 Jul;77(1):161-5. doi: 10.1097/TA.0000000000000251.
BACKGROUND
Gender alone offers no survival advantage in humans following trauma. However, male gender does predict increased morbidity, specifically ventilator-associated pneumonia (VAP). Previous work has shown that despite lower incidence of VAP, females with VAP have increased mortality. The purposes of this study were to evaluate the impact of VAP and gender on outcome and to determine which characteristics of severe VAP predict mortality in trauma patients.
METHODS
Patients with VAP (≥10 colony-forming units per milliliter in bronchoalveolar lavage) over 8 years were stratified by gender, age, severity of shock, and injury severity. Severe VAP factors were defined as multiple-episode, polymicrobial, multidrug-resistant, nosocomial VAP diagnosed within 7 days of admission (eNVAP), and multiple inadequate empiric antibiotic therapy episodes. Mortality and severe VAP factors were compared using χ analysis. Multivariable logistic regression (MLR) was performed to determine which VAP factors were independent predictors of mortality.
RESULTS
A total of 854 patients were identified, 676 men (79%) and 178 women (21%). Despite a higher incidence of VAP among males (3.8% vs. 2.6%, p = 0.001), mortality was higher in females (24% vs. 15%, p = .009). All characteristics of severe VAP were increased in females except multiple episodes (p = 0.15). MLR identified eNVAP as an independent predictor of mortality in females with severe VAP after adjusting for age, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), admission base excess, and 24-hour transfusions (odds ratio, 9.97; p = 0.001).
CONCLUSION
That females develop less VAP but experience increased mortality confirms previous studies. Characteristics of severe VAP are increased in females and may contribute to this observed mortality difference. MLR identified eNVAP as an independent predictor of mortality in females with severe VAP following trauma.
LEVEL OF EVIDENCE
Epidemiologic/prognostic study, level III.
背景
在创伤后，仅男性性别并不能提供生存优势。然而，男性性别确实预测发病率增加，特别是呼吸机相关性肺炎（VAP）。先前的研究表明，尽管 VAP 的发病率较低，但患有 VAP 的女性死亡率增加。本研究的目的是评估 VAP 和性别对结果的影响，并确定严重 VAP 的哪些特征可预测创伤患者的死亡率。
方法
在 8 年期间，将 VAP（支气管肺泡灌洗液中每毫升 10 个以上的菌落形成单位）患者按性别、年龄、休克严重程度和损伤严重程度分层。严重 VAP 因素定义为多发性、多微生物、多种药物耐药、医院获得性 VAP，在入院后 7 天内诊断（eNVAP），以及多次经验性抗生素治疗不足的发作。使用卡方分析比较死亡率和严重 VAP 因素。进行多变量逻辑回归（MLR）以确定哪些 VAP 因素是死亡率的独立预测因素。
结果
共确定了 854 例患者，其中 676 例男性（79％）和 178 例女性（21％）。尽管男性 VAP 的发生率较高（3.8％比 2.6％，p = 0.001），但女性死亡率更高（24％比 15％，p = 0.009）。除了多次发作（p = 0.15）外，所有严重 VAP 的特征在女性中均增加。在调整年龄、格拉斯哥昏迷量表（GCS）评分、损伤严重程度评分（ISS）、入院基础不足和 24 小时输血后，MLR 将 eNVAP 确定为女性严重 VAP 死亡率的独立预测因素（优势比，9.97；p = 0.001）。
结论
女性发生的 VAP 较少，但死亡率却增加，这证实了先前的研究。严重 VAP 的特征在女性中增加，可能导致观察到的死亡率差异。MLR 将 eNVAP 确定为创伤后女性严重 VAP 死亡率的独立预测因素。
证据水平
流行病学/预后研究，III 级。
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