Association of gender with outcomes in critically ill patients.
Association of gender with outcomes in critically ill patients.
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DOI：
10.1186/cc11355
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发表时间：
2012-05-22
期刊：
影响因子：
--
通讯作者：
Wahidi MM
中科院分区：
文献类型：
--
作者：
Mahmood K;Eldeirawi K;Wahidi MM
性别对危重患者死亡率和其他结果的影响尚不清楚。在不同的环境和患者群体中进行了不同的研究，常常会产生相互矛盾的结果。我们想要评估急性生理学和慢性健康评估 (APACHE) IV 数据库（Cerner Corporation，美国）中患者的性别与重症监护病房 (ICU) 结局之间的关系。我们对 APACHE IV 数据库中的可用数据进行了回顾性审查。 2004年1月1日至2008年12月31日期间，共有261,255名连续入住美国成人ICU的患者被纳入研究。再入院被排除在分析之外。该研究的主要目的是评估性别与 ICU 死亡率的关系。次要目标是评估性别与积极治疗、机械通气、ICU 住院时间、再入院率和医院死亡率的关系。还评估了疾病亚组的性别相关结局，包括急性冠状动脉综合征、冠状动脉搭桥术（CABG）手术、脓毒症、创伤和慢性阻塞性肺病（COPD）恶化。 ICU 死亡率男性为 7.2%，女性为 7.9%，女性死亡比值比 (OR) 为 1.07（95% 置信区间 (CI)：1.04 至 1.1）。性别和年龄之间存在统计学上显着的交互作用。在调整急性生理学评分、种族、共病情况、ICU 前住院时间、ICU 前位置和医院教学状况后，与男性相比，在年龄 <50 岁的患者中，女性的 ICU 死亡率降低（调整后 OR 0.83，95% CI：0.76 至 0.91）。但在≥50岁的患者中，男性和女性的ICU死亡率没有显着差异（调整后OR 1.02，95% CI：0.98至1.06）。接受机械通气、急诊手术、溶栓治疗和冠状动脉搭桥手术的男性比例较高。男性的再入院率更高，ICU 住院时间更长。与男性相比，接受 CABG 的女性调整后死亡率较高，而 COPD 恶化时女性的调整死亡率较低。急性冠脉综合征、败血症和创伤的死亡率没有显着差异。重症患者中，50岁以下女性ICU死亡率低于男性，而50岁以上女性与男性相比差异不显着。与男性相比，女性在 CABG 手术后的死亡率较高，而 COPD 恶化时的死亡率较低。急性冠状动脉综合征、脓毒症或创伤的死亡率没有差异。
The influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner Corporation, USA). We performed a retrospective review of the data available in the APACHE IV database. A total of 261,255 consecutive patients admitted to adult ICUs in United States from 1 January 2004 to 31 December 2008 were included. Readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with active therapy, mechanical ventilation, length of stay in the ICU, readmission rate and hospital mortality. The gender-related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well. ICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval (CI): 1.04 to 1.1). There was a statistically significant interaction between gender and age. In patients <50 years of age, women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (adjusted OR 0.83, 95% CI: 0.76 to 0.91). But among patients ≥50 years of age, there was no significant difference in ICU mortality between men and women (adjusted OR 1.02, 95% CI: 0.98 to 1.06). A higher proportion of men received mechanical ventilation, emergent surgery, thrombolytic therapy and CABG surgery. Men had a higher readmission rate and longer length of ICU stay. The adjusted mortality of women compared to men was higher with CABG, while it was lower with COPD exacerbation. There was no significant difference in mortality in acute coronary syndrome, sepsis and trauma. Among the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant difference compared to men. Women had a higher mortality compared to men after CABG surgery and lower mortality with COPD exacerbation. There was no difference in mortality in acute coronary syndrome, sepsis or trauma.
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