危重症患者重要器官支持的性别差异。

Sex Differences in Vital Organ Support Provided to ICU Patients.

机构信息

Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.

Intensive Care Unit, Austin Health, Melbourne, VIC, Australia.

出版信息

Crit Care Med. 2024 Jan 1;52(1):1-10. doi: 10.1097/CCM.0000000000006058. Epub 2023 Oct 16.

DOI:10.1097/CCM.0000000000006058

PMID:37846932

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10715697/

Abstract

OBJECTIVES

Critically ill women may receive less vital organ support than men but the mortality impact of this differential treatment remains unclear. We aimed to quantify sex differences in vital organ support provided to adult ICU patients and describe the relationship between sex, vital organ support, and mortality.

DESIGN

In this retrospective observational study, we examined the provision of invasive ventilation (primary outcome), noninvasive ventilation, vasoactive medication, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), or any one of these five vital organ supports in women compared with men. We performed logistic regression investigating the association of sex with each vital organ support, adjusted for illness severity, diagnosis, preexisting treatment limitation, year, and hospital. We performed logistic regression for hospital mortality adjusted for the same variables, stratified by vital organ support (secondary outcome).

SETTING AND PATIENTS

ICU admissions in the Australia and New Zealand Intensive Care Society Adult Patient Database 2018-2021. This registry records admissions from 90% of ICUs in the two nations.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We examined 699,535 ICU admissions (43.7% women) to 199 ICUs. After adjustment, women were less likely than men to receive invasive ventilation (odds ratio [OR], 0.64; 99% CI, 0.63-0.65) and each other organ support except ECMO. Women had lower adjusted hospital mortality overall (OR, 0.94; 99% CI, 0.91-0.97). Among patients who did not receive any organ support, women had significantly lower adjusted hospital mortality (OR, 0.82; 99% CI, 0.76-0.88); among patients who received any organ support women and men were equally likely to die (OR, 1.01; 99% CI, 0.97-1.04).

CONCLUSIONS

Women received significantly less vital organ support than men in ICUs in Australia and New Zealand. However, our findings suggest that women may not be harmed by this conservative approach to treatment.

摘要

目的

危重症女性患者可能接受的重要器官支持治疗少于男性，但这种治疗差异对死亡率的影响尚不清楚。本研究旨在定量评估成人 ICU 患者接受重要器官支持治疗的性别差异，并描述性别、重要器官支持治疗与死亡率之间的关系。

设计

本回顾性观察性研究比较了女性与男性患者接受有创通气（主要结局）、无创通气、血管活性药物、肾脏替代治疗、体外膜肺氧合（ECMO）或这五种重要器官支持中的任何一种的情况。我们采用 logistic 回归分析，在调整了疾病严重程度、诊断、预先存在的治疗限制、年份和医院后，研究了性别与每种重要器官支持治疗的关系。我们对医院死亡率进行了 logistic 回归分析，该分析也在调整了上述变量的基础上按重要器官支持治疗分层（次要结局）。

地点和患者

2018-2021 年澳大利亚和新西兰重症监护学会成人患者数据库的 ICU 入院患者。该数据库记录了来自这两个国家 90%的 ICU 的入院信息。

干预措施

无。

测量和主要结果

我们共纳入了来自 199 家医院的 699535 例 ICU 入院患者（43.7%为女性）。校正后，女性患者接受有创通气（比值比 [OR]，0.64；99%置信区间 [CI]，0.63-0.65）和其他每种器官支持治疗（除外 ECMO）的可能性均低于男性。总体而言，女性患者的校正后医院死亡率较低（OR，0.94；99%CI，0.91-0.97）。在未接受任何器官支持治疗的患者中，女性的校正后医院死亡率显著更低（OR，0.82；99%CI，0.76-0.88）；而在接受任何器官支持治疗的患者中，女性和男性的死亡率相当（OR，1.01；99%CI，0.97-1.04）。