男性在脑出血后肺炎和死亡的风险更高。
Men Experience Higher Risk of Pneumonia and Death After Intracerebral Hemorrhage.
机构信息
Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA.
J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Neurocrit Care. 2018 Feb;28(1):77-82. doi: 10.1007/s12028-017-0431-6.
BACKGROUND
Infectious complications worsen outcome after intracerebral hemorrhage (ICH). We investigated the impact of sex on post-ICH infections and mortality.
METHODS
Consecutive ICH patients (admitted to a single hospital between 1994 and 2015) were retrospectively assessed via chart review to ascertain the following in-hospital infections: urinary tract infection (UTI), pneumonia, and sepsis. Adjusted logistic regression was performed to identify associations between sex, infection, and mortality at 90 days.
RESULTS
Two thousand and four patients were investigated, 1071 (53.7%) males. Men were more likely to develop pneumonia (21.9 vs 15.5% p < 0.001) and sepsis (3.4 vs 1.6%, p = 0.009), whereas women had higher risk of UTI (19.9 vs 11.7% p < 0.001). Multivariate analyses confirmed association between male sex and pneumonia (Odds Ratio (OR) 1.37, 95% confidence interval (CI) 1.08-1.74, p = 0.011). Male sex (OR 1.40; CI 1.07-1.85; p = 0.015) and infection (OR 1.56; CI 1.11-1.85; p = 0.011) were independently associated with higher 90-day mortality.
CONCLUSIONS
Types and rates of infection following ICH differ by sex. Male sex independently increases pneumonia risk, which subsequently increases 90-day mortality. Sex-specific preventive strategies to reduce the risk of these complications may be one strategy to improve ICH outcomes.
背景
感染并发症会使脑出血（ICH）患者的预后恶化。我们研究了性别对ICH 后感染和死亡率的影响。
方法
通过病历回顾对连续ICH 患者（1994 年至 2015 年期间在一家医院住院的患者）进行回顾性评估，以确定以下院内感染：尿路感染（UTI）、肺炎和败血症。采用调整后的逻辑回归来确定性别、感染与 90 天死亡率之间的关系。
结果
共调查了 2400 例患者，其中 1071 例（53.7%）为男性。男性更容易发生肺炎（21.9%比 15.5%，p<0.001）和败血症（3.4%比 1.6%，p=0.009），而女性 UTI 风险更高（19.9%比 11.7%，p<0.001）。多变量分析证实，男性与肺炎之间存在关联（优势比（OR）为 1.37，95%置信区间（CI）为 1.08-1.74，p=0.011）。男性（OR 1.40；CI 1.07-1.85；p=0.015）和感染（OR 1.56；CI 1.11-1.85；p=0.011）与 90 天死亡率升高独立相关。
结论
ICH 后感染的类型和发生率存在性别差异。男性独立增加肺炎风险，进而增加 90 天死亡率。针对这些并发症风险的性别特异性预防策略可能是改善 ICH 结局的策略之一。
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