Association of gender with outcomes in critically ill patients

Abstract

IntroductionThe 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).MethodsWe 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.ResultsICU 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.ConclusionsAmong 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.

Sex and Mortality of Hospitalized Adults After Admission to an Intensive Care Unit

“…Similar findings have been reported previously, 2,7,13 although some controversy remains. [14][15][16] The reasons women may have a higher mortality than men during a critical illness are poorly understood, and clinical studies [17][18][19] have shown that women have higher mortality rates than men do despite biological evidence of the protective effect of estrogens on both immune function and cardiovascular responses.…”

“…We conducted a retrospective study to determine if delays in ICU admission and severity of illness before ICU admission differed between men and women who were already hospitalized and if ICU mortality differed according to sex between medical and surgical patients. We also sought to confirm previous reports that differences in mortality between the sexes are more pronounced in younger patients 7 and in patients who were less severely ill. 8 …”

Prognostic Value of Red Cell Distribution Width in Critically Ill Patients and Comparison with Intensive Care Unit Scoring Systems

“…Mahmood et al (12) explored the relation between age and clinical course and found no significant difference between female and male patients who were aged 50 years and older, but the mortality at the age of 50 years was lower in female patients than in male patients. Jacobson et al (13) conducted a prospective observational cohort with the patients internalized in the ICU for a 3-year period; with sepsis in the first 24 h, no correlation was found between mortality, hospitalization duration, and gender.…”

Female Gender and Patient Outcomes Female Gender... Is It Really A Risk Or A Boon?

“…But, no difference in mortality was shown in patients with CAD, sepsis or trauma. [12] With respect to epidemiology, Sakr et al reported more male admissions compared to females and even the prevalence of sepsis was lower in females. But the incidence of ICU mortality was more with female patients with severe sepsis.…”