成年癫痫持续状态患者的性别差异：一项为期七年的两中心观察研究。
Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation.
机构信息
Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland.
Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland.
出版信息
Crit Care. 2023 Aug 5;27(1):308. doi: 10.1186/s13054-023-04592-6.
BACKGROUND
Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers.
METHODS
In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women.
RESULTS
Among 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004).
CONCLUSIONS
This study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.
背景
关于性别对癫痫持续状态（SE）的发展、治疗、病程和结局的影响，存在相互矛盾的发现。我们的研究旨在调查瑞士两所学术医疗中心成年 SE 患者的性别差异，重点关注治疗、疾病过程和结局。
方法
在这项回顾性研究中，纳入了 2015 年至 2021 年期间在瑞士巴塞尔和日内瓦的两所学术护理中心接受 SE 治疗的患者。主要结局是恢复到发病前的神经功能、住院期间和 30 天内死亡。次要结局包括治疗和疾病过程的特征。使用多变量逻辑回归评估主要和次要结局的相关性。为了平衡男女之间的年龄差异，使用倾向评分匹配进行了分析。
结果
在 762 名 SE 患者中，45.9%为女性。除了女性年龄较大和颅内出血频率较低外，男女之间没有发现性别差异。与男性相比，女性的中位年龄更高（70 岁 vs. 66 岁，p=0.003），非昏迷性局灶性无癫痫发作更常见（34.9% vs. 25.5%；p=0.005），伴有运动症状的 SE 更少见（52.3% vs. 63.6%，p=0.002）。女性 SE 持续时间更长（1 天 vs. 0.5 天，p=0.011），与男性相比，难治性 SE 的比例相似（36.9% vs. 36.4%，p=0.898），但麻醉和机械通气的频率较低（30.6% vs. 42%，p=0.001）。在未匹配的多变量分析中，年龄与所有主要结局相关，但与女性性别无关。相反，倾向评分匹配的多变量分析显示，女性在回归到发病前的神经功能方面的几率降低，这与潜在的混杂因素无关。出院时，女性回家的比例较低（29.7% vs. 43.7%，p<0.001），去疗养院的比例较高（17.1% vs. 10.0%，p=0.004）。
结论
这项研究确定了成年 SE 患者在临床特征、治疗方式和结局方面的性别差异，女性处于不利地位，这意味着在制定管理 SE 和预测结局的策略时，必须考虑基于性别的因素。
Zotero 插件