Edmonton Clinic Health Academy (ECHA), 11405-87th Ave., Edmonton, Alberta, Canada.
Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.
Nurs Crit Care. 2017 Sep;22(5):284-292. doi: 10.1111/nicc.12280. Epub 2017 Mar 12.
Men and women appear to exhibit different susceptibilities to sepsis and possibly divergent outcomes. However, the effect of sex and gender in critical illness outcomes is still controversial and the underlying mechanisms appear to be complex.
We aimed to systematically review and synthesize evidence on the influence of sex on outcomes in critically ill adult patients with sepsis, as reported in published studies specifically including investigation of the effect of sex among their aims. Primary outcome measures include in-hospital mortality, intensive care unit (ICU) mortality and length of stay (LOS) in the ICU.
The review was based on focused literature searches (CINAHL, PUBMED, EMBASE and COCHRANE). Methodological quality was assessed through the STROBE checklist and the Cochrane Tool for Bias in Cohort Studies. Meta-analysis was performed using STATA. Published observational studies addressing outcomes of sepsis among their primary aims and having included gender comparisons among primary outcomes in critically ill adult patients were included.
A total of eight eligible studies were included. With the exception of mortality, it was not possible to perform meta-analysis for other outcomes. Included studies reported data on 25,619 patients with sepsis (14 309 male/11 310 female). There is a paucity of well-designed studies addressing the effect of sex on mortality among patients with sepsis, and absence of studies addressing the effects of sex on multiple organ dysfunction of non-infectious origin. There was significant heterogeneity among study estimates (p = 0·001; I =78·1%).
Although results of data syntheses appear to point towards a small disadvantage for survival among women, our results suggest that data on the impact of sex on sepsis outcomes remain equivocal. Implications for future research include approaches to adjustment for confounders and prospective designs.
Clarifying sex-related differences in sepsis, if any, is crucial for informing evidence-based care.
男性和女性似乎对脓毒症表现出不同的易感性，并且可能存在不同的结局。然而，性别对危重病患者结局的影响仍存在争议，其潜在机制似乎很复杂。
我们旨在系统地回顾和综合评估已发表的研究中性别对成年脓毒症患者结局影响的证据，这些研究特别包括了其研究目的中对性别的影响的调查。主要结局指标包括院内死亡率、重症监护病房（ICU）死亡率和 ICU 住院时间（LOS）。
综述基于有针对性的文献检索（CINAHL、PUBMED、EMBASE 和 COCHRANE）。通过 STROBE 清单和 Cochrane 偏倚风险评估工具对方法学质量进行评估。使用 STATA 进行荟萃分析。纳入了主要目的为脓毒症结局，并在主要结局中进行了性别比较的观察性研究。
共纳入 8 项符合条件的研究。除死亡率外，其他结局无法进行荟萃分析。纳入的研究报告了 25619 例脓毒症患者的数据（男性 14309 例，女性 11310 例）。目前，针对性别对脓毒症患者死亡率影响的设计良好的研究很少，并且没有研究涉及非感染性多器官功能障碍的性别影响。研究估计之间存在显著的异质性（p = 0·001；I = 78·1%）。
尽管数据综合结果似乎表明女性的生存优势较小，但我们的结果表明，关于性别对脓毒症结局影响的数据仍存在争议。未来研究的意义包括调整混杂因素和前瞻性设计的方法。
阐明脓毒症相关的性别差异至关重要，这有助于为循证护理提供信息。
