Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Menzies School of Health Research, Charles Darwin University, Darwin, Winnellie, NT, Australia.
J Crit Care. 2019 Feb;49:70-76. doi: 10.1016/j.jcrc.2018.10.017. Epub 2018 Oct 23.
To investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI).
Post-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial.
Of 724 patients, 458 (63.3%) were male and 266 (36.7%) were female. The mean delivered effluent flow rate was 25.6 ± 7.4 ml/kg/h (80 ± 15% of prescribed dose) in males and 27.4 ± 7.6 ml/kg/h (83 ± 15% of prescribed dose) in females (p = .01). A total of 237 (51.7%) males and 118 (44.5%) females died within 90 days of randomization (p = .06). The adjusted hazard ratio (HR) for 90-day mortality was significantly decreased in females as compared with males (HR 0.74, 95% CI 0.57 to 0.96, p = .02). The relationship between sex and mortality was not significantly altered by menopausal status (adjusted P value for interaction 0.99) or by RRT intensity allocation (adjusted P value for interaction 0.27).
In a cohort of patients with sepsis and severe AKI, female sex was associated with improved survival. The relationship between sex and survival was not altered by menopausal status or RRT intensity.
探讨性别与死亡率之间的关系，以及绝经状态或肾脏替代治疗（RRT）强度是否会改变严重脓毒症急性肾损伤（AKI）患者的这种关系。
对随机评估正常与增强水平肾脏替代治疗（RENAL）试验中纳入的脓毒症患者进行了事后分析。
在 724 例患者中，458 例（63.3%）为男性，266 例（36.7%）为女性。男性的实际透出液流量均值为 25.6±7.4ml/kg/h（80±15%的处方剂量），女性为 27.4±7.6ml/kg/h（83±15%的处方剂量）（p=0.01）。共有 237 例（51.7%）男性和 118 例（44.5%）女性在随机分组后 90 天内死亡（p=0.06）。与男性相比，女性 90 天死亡率的调整后的危险比（HR）显著降低（HR 0.74，95%CI 0.57 至 0.96，p=0.02）。性别与死亡率之间的关系不因绝经状态（调整后的交互检验 p 值为 0.99）或 RRT 强度分配（调整后的交互检验 p 值为 0.27）而改变。
在脓毒症和严重 AKI 患者队列中，女性性别与生存改善相关。性别与生存之间的关系不受绝经状态或 RRT 强度的影响。
