危重症脓毒症患者的性别特异性结局和处理。
Sex-specific outcomes and management in critically ill septic patients.
机构信息
Paracelsus Medical University of Salzburg, Austria, Department of Cardiology, Clinic of Internal Medicine II, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Germany.
出版信息
Eur J Intern Med. 2021 Jan;83:74-77. doi: 10.1016/j.ejim.2020.10.009. Epub 2020 Oct 12.
BACKGROUND
Female and male critically ill septic patients might differ with regards to risk distribution, management, and outcomes. We aimed to compare male versus female septic patients in a large collective with regards to baseline risk distribution and outcomes.
METHODS
In total, 17,146 patients were included in this analysis, 8781 (51%) male and 8365 (49%) female patients. The primary endpoint was ICU-mortality. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analyses were used to assess sex-specific differences.
RESULTS
Female patients had lower SOFA scores (5 ± 5 vs. 6 ± 6; p<0.001) and creatinine (1.20±1.35 vs. 1.40±1.54; p<0.001). In the total cohort, the ICU mortality was 10% and similar between female and male (10% vs. 10%; p = 0.34) patients. The ICU remained similar between sexes after adjustment in model-1 (aOR 1.05 95% CI 0.95-1.16; p = 0.34); model-2 (aOR 0.91 95% CI 0.79-1.05; p = 0.18) and model-3 (aOR 0.93 95% CI 0.80-1.07; p = 0.29). In sensitivity analyses, no major sex-specific differences in mortality could be detected.
CONCLUSION
In this study no clinically relevant sex-specific mortality differences could be detected in critically ill septic patients. Possible subtle gender differences could play a minor role in the acute situation due to the severity of the disease in septic patients.
背景
女性和男性危重病脓毒症患者在风险分布、治疗和结局方面可能存在差异。我们旨在比较大量脓毒症患者中男性与女性患者在基线风险分布和结局方面的差异。
方法
共纳入 17146 例患者,其中 8781 例(51%)为男性,8365 例(49%)为女性。主要终点为 ICU 死亡率。记录了基线特征和器官支持的数据。使用多水平逻辑回归分析评估性别特异性差异。
结果
女性患者的 SOFA 评分(5 ± 5 与 6 ± 6;p<0.001)和肌酐(1.20±1.35 与 1.40±1.54;p<0.001)较低。在总队列中,ICU 死亡率为 10%,女性和男性患者相似(10%比 10%;p = 0.34)。在模型-1(调整后 aOR 1.05 95% CI 0.95-1.16;p = 0.34)、模型-2(aOR 0.91 95% CI 0.79-1.05;p = 0.18)和模型-3(aOR 0.93 95% CI 0.80-1.07;p = 0.29)中,ICU 死亡率在性别之间仍相似。在敏感性分析中,未发现死亡率存在有临床意义的性别特异性差异。
结论
在这项研究中,没有发现危重病脓毒症患者在死亡率方面存在明显的性别特异性差异。由于脓毒症患者病情严重,可能存在细微的性别差异,但在急性情况下作用较小。