Gender and Acute Respiratory Distress Syndrome in Critically Injured Adults: A Prospective Study
Gender and Acute Respiratory Distress Syndrome in Critically Injured Adults: A Prospective Study
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DOI：
10.1097/ta.0b013e31822c0d31
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发表时间：
2011-10-01
影响因子：
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通讯作者：
May, Addison K.
中科院分区：
文献类型：
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作者：
Heffernan, Daithi S.;Dossett, Lesly A.;May, Addison K.
背景：急性呼吸窘迫综合征（ARDS）是一种常并发创伤和危重病的促炎性疾病。动物研究表明，性别和性激素在炎症调节中起着重要作用。关于性别和性激素在发展ARDS中的作用的人类数据很少。我们的目的是描述性别和激素的差异，在一个大的严重受伤的adults.Methods的队列中发展ARDS的患者：一个前瞻性队列研究的成人创伤患者需要重症监护病房入院至少48小时进行。前瞻性收集人口统计学和临床数据，并在研究入组时（48小时）测定性激素。主要结局是ARDS的发展。多变量logistic回归分析用于确定调整后的死亡几率与性别差异相关。结果：六百四十八例患者符合入选标准，180例患者发生ARDS（31%）。女性更容易发生ARDS（35% vs. 25%，p = 0.02）。在调整年龄、损伤机制、损伤严重程度和血液制品输注后，这种相关性仍然存在（比值比，1.6; 95%置信区间：1.1-2.4; p = 0.02）。在ARDS患者中，与性别相关的死亡率没有差异（女性ARDS患者死亡率为22%，男性为20%; p =不显著）。促炎性性激素的配置文件（低睾酮和高雌二醇）与ARDS在男性和women.Conclusion：女性比男性更有可能发展成ARDS后，严重损伤。尽管ARDS的发病率增加，但ARDS患者的死亡率并不因性别而异。性激素的炎症特性可能导致ARDS，但它们不能完全解释观察到的性别差异。
Background: The acute respiratory distress syndrome (ARDS) is a proinflammatory condition that often complicates trauma and critical illness. Animal studies have shown that both gender and sex hormones play an important role in inflammatory regulation. Human data are scant regarding the role of gender and sex hormones in developing ARDS. Our objective was to describe gender and hormonal differences in patients who develop ARDS in a large cohort of critically injured adults.Methods: A prospective cohort study of adult trauma patients requiring intensive care unit admission for at least 48 hours was performed. Demographic and clinical data were collected prospectively, and sex hormones were assayed at study entry (48 hours). The primary outcome was the development of ARDS. Multivariate logistic regression was used to determine the adjusted odds of death associated with differences in gender.Results: Six hundred forty-eight patients met entry criteria, and 180 patients developed ARDS (31%). Women were more likely to develop ARDS (35% vs. 25%, p = 0.02). This association remained after adjusting for age, mechanism of injury, injury severity, and blood product transfusion (odds ratio, 1.6; 95% confidence interval: 1.1-2.4; p = 0.02). Of patients with ARDS, there was no difference in mortality related to gender (22% mortality in women with ARDS vs. 20% in men; p = not significant). A proinflammatory sex hormone profile (low testosterone and high estradiol) was associated with ARDS in both men and women.Conclusion: Women are more likely than men to develop ARDS after critical injury. Despite the increased incidence in ARDS, the mortality in patients with ARDS does not differ according to gender. The inflammatory properties of sex hormones may contribute to ARDS, but they do not fully explain observed gender differences.