Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age.
Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age.
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DOI：
10.1186/s13054-015-0873-1
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发表时间：
2015-03-30
期刊：
影响因子：
--
通讯作者：
Walther SM
中科院分区：
文献类型：
--
作者：
Samuelsson C;Sjöberg F;Karlström G;Nolin T;Walther SM
临床前数据表明，雌激素似乎在危重病的病理生理学和恢复中起着有益的作用。然而，在以前的流行病学研究中，研究人员在处理重症监护结果的潜在性别差异时，将绝经前妇女作为一个单独的群体进行分析。我们的目的是观察绝经前妇女在重症监护后是否有更好的结果，并调查性别与重症监护室（ICU）资源使用之间的关系。根据我们对2008年至2012年127，254例连续的简化急性生理学评分III评分的瑞典重症监护登记处ICU入院的分析，我们确定了风险调整后的30天死亡率，累计护士工作量评分和ICU住院时间。为了研究与性别的相关性，我们对整个队列以及按绝经中位年龄分层的两个亚组（≤ 45岁和> 45岁）和六个选定的诊断亚组（败血症、多发性创伤、慢性阻塞性肺疾病、急性呼吸窘迫综合征、肺炎和心脏骤停）进行了logistic回归和多变量分析。整个队列的风险调整死亡率没有性别差异，45岁及以下组的风险调整死亡率也没有性别差异。对于年龄大于45岁的患者组，我们发现因心脏骤停入院的男性的风险调整死亡率降低。对于作为一个整体的队列，以及那些因多发性创伤而入院的患者，男性与较高的护士工作量评分和较长的ICU住院时间相关。使用来自一个大型多ICU登记数据库的信息，我们发现，在瑞典，绝经前女性性别与重症监护后的生存优势无关。当数据根据年龄和疾病严重程度进行调整时，我们发现男性每次入院使用的ICU资源比女性多。本文的在线版本（doi：10.1186/s13054-015-0873-1）包含补充材料，可供授权用户使用。
Preclinical data indicate that oestrogen appears to play a beneficial role in the pathophysiology of and recovery from critical illness. In few previous epidemiologic studies, however, have researchers analysed premenopausal women as a separate group when addressing potential gender differences in critical care outcome. Our aim was to see if women of premenopausal age have a better outcome following critical care and to investigate the association between gender and use of intensive care unit (ICU) resources. On the basis of our analysis of 127,254 consecutive Simplified Acute Physiology Score III–scored Swedish Intensive Care Registry ICU admissions from 2008 through 2012, we determined the risk-adjusted 30-day mortality, accumulated nurse workload score and ICU length of stay. To investigate associations with sex, we used logistic regression and multivariate analyses on the entire cohort as well as on two subgroups stratified by median age for menopause (up to and including 45 years and older than 45 years) and six selected diagnostic subgroups (sepsis, multiple trauma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia and cardiac arrest). There was no sex difference in risk-adjusted mortality for the cohort as a whole, and there was no sex difference in risk-adjusted mortality in the group 45 years of age and younger. For the group of patients older than 45 years of age, we found a reduced risk-adjusted mortality in men admitted for cardiac arrest. For the cohort as a whole, and for those admitted with multiple trauma, male sex was associated with a higher nurse workload score and a longer ICU stay. Using information derived from a large multiple ICU register database, we found that premenopausal female sex was not associated with a survival advantage following intensive care in Sweden. When the data were adjusted for age and severity of illness, we found that men used more ICU resources per admission than women did. The online version of this article (doi:10.1186/s13054-015-0873-1) contains supplementary material, which is available to authorized users.
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DOI：
10.1097/ta.0b013e31822c0d31
发表时间：
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影响因子：
--
作者：
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