Influence of gender on the outcome of severe sepsis - A reappraisal
Influence of gender on the outcome of severe sepsis - A reappraisal
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DOI：
10.1378/chest.07-0420
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发表时间：
2007-12-01
期刊：
影响因子：
9.6
通讯作者：
Timsit, Jean Francois
中科院分区：
文献类型：
--
作者：
Adrie, Christophe;Azoulay, Elie;Timsit, Jean Francois
背景：性别对严重脓毒症患者生存的影响尚不清楚。早期的研究表明女性的存活率更高，这可能与性类固醇有关。方法：为了研究男性严重脓毒症的死亡率是否高于女性，以及这种差异是否随绝经期而变化，我们研究了纳入OutcomeRea数据库的1692例严重脓毒症患者，时间长达8年。我们进行了一项巢式病例对照研究，在三个标准上准确匹配男性和女性：死亡倾向评分、年龄和中心。对50岁的个体（男性与绝经后女性）进行亚组分析。结果：我们匹配了1000名男性和608名女性严重脓毒症患者，在调整混杂因素（即慢性呼吸衰竭、转移性癌症、免疫功能低下状态、急诊手术、急性呼吸衰竭和入院时休克、尿路感染和微生物类型）前后。女性的总体住院死亡率显著降低（校正优势比[OR]， 0.75； 95%可信区间[CI]， 0.57 ~ 0.97; p = 0.02）。在50岁组（481名女性，778名男性）中，女性住院死亡率显著降低（OR, 0.69; 95% CI， 0.52至0.93;p = 0.014）。在年轻组中，男女住院死亡率无显著差异（女性127人，男性222人）[OR, 1.01；95% CI, 0.52 ~ 1.97;P = 0.98]。护理水平，使用护理人力使用分数的9个等价物进行评估，在男性和女性中是相同的。结论：在50岁至50岁的严重脓毒症患者中，女性住院死亡风险低于男性。
Background: The influence of gender on survival of patients with severe sepsis is unclear. Earlier studies suggested better survival in women, possibly related to the sex-steroid profile.Methods: To investigate whether mortality from severe sepsis was higher in men than in women and whether the difference varied with menopausal status, we studied 1,692 patients with severe sepsis included in the OutcomeRea database over an 8-year period. We conducted a nested case-control study, accurately matching men and women on three criteria: a death propensity score, age, and center. Subgroup analyses were performed on individuals 50 years old (men vs postmenopausal women).Results: We matched 1,000 men to 608 women with severe sepsis before and after adjustment for confounding factors (ie, chronic respiratory failure; metastatic cancer; immunocompromised status; emergency surgery, acute respiratory failure, and shock at admission; urinary tract infection; and type of microorganism). Overall hospital mortality was significantly lower in women (adjusted odds ratio [OR], 0.75; 95% confidence interval [CI], 0.57 to 0.97; p = 0.02). In the group > 50 years old (481 women, 778 men), hospital mortality was significantly lower in women (OR, 0.69; 95% CI, 0.52 to 0.93; p = 0.014). Hospital mortality was not significantly different between men and women in the younger group (127 women, 222 men) [OR, 1.01; 95% CI, 0.52 to 1.97; p = 0.98]. Level of care, as assessed using the nine equivalents of nursing manpower use score, was identical in men and women.Conclusions: Among individuals > 50 years old with severe sepsis, women have a lower risk of hospital mortality than men.