Association of Sex With Clinical Outcome in Critically Ill Sepsis Patients: A Retrospective Analysis of the Large Clinical Database MIMIC-III

Xu, Jinghong; Li, Tong; Yao, Jiyou; Guo, Zilu; Lui, Ka Yin; Hu, Xiaoguang; Cao, Lu; Zhu, Yueyong; Huang, Feng; Guan, Xiangdong; Cai, Changjie

doi:10.1097/shk.0000000000001253

Cited by 52 publications

(51 citation statements)

References 29 publications

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“…Out of these studies, two are awaiting classi cation [40,41], and another one is ongoing [42] (See Supplementary Tables 5 and 6, Additional File 1, respectively). Finally, the review included 12 studies [43][44][45][46][47][48][49][50][51][52][53][54] (Fig. 1).…”

Section: Studies Research and Characteristicsmentioning

confidence: 99%

“…1 (Additional File 1) depicts the risk of bias assessment at outcome level of each included study using the QUIPS tool. We rated over half of the studies [43,45,46,48,50,53] as having low risk in study participation, study attrition, and outcome measurement domains. We assessed all studies as having unclear risk in the prognosis factor domain, given that none provided any de nition or adequate description of the sex/gender variable.…”

Section: Studies Research and Characteristicsmentioning

confidence: 99%

“…The risk of bias for the adjustment for other prognosis factors domain was moderate for over half of the studies [45-48, 52, 53] and low for the others [43,44,[49][50][51] because of a minimal or acceptable adjustment, respectively. We penalised two studies [46,53] that provided insu cient data presentation as moderate risk in the statistical analysis and reporting domain, while we classi ed the remaining studies as low risk of bias.…”

Section: Studies Research and Characteristicsmentioning

confidence: 99%

“…We investigated the independent prognostic effect of sex on all-cause hospital mortality. We found six studies [43,44,46,49,53,54] (29346 recruited participants) addressing this question. Among the four studies [43,44,46,49] (21059 analysed participants) that provided adjusted results, three of them [43,44,49] (20245 analysed participants) presented su ciently similar data allowing quantitative synthesis.…”

Section: Primary Outcomesmentioning

confidence: 99%

“…We examined sex-based differences in 28-day all-cause hospital mortality. We found six studies [44,[50][51][52][53][54] (20930 recruited participants) addressing this question. Three studies [44,51,52] (12579 analysed participants) provided adjusted results.…”

Section: Primary Outcomesmentioning

confidence: 99%

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Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: a systematic review and meta-analysis

Antequera

López‐Alcalde

Stallings

et al. 2020

Preprint

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Background: Incidence and sepsis-related mortality are failing, but sepsis continues to be a leading cause of admission and death in intensive care units (ICUs). Although the preceding evidence suggests sex-related risk differences for developing sepsis, the influence of sex on mortality outcomes remains unclear as previous studies showed discordant results. This systematic review assesed the independent effect of sex for mortality among critically ill patients with sepsis.Methods: Electronic databases were searched up to 17th July 2020 for studies that examined independent associations between sex and mortality outcomes in critically ill adults with sepsis while controlling for covariates. Primary meta-analyses were performed by pooling adjusted estimates for a pre-specified core set of adjustment factors. The primary outcomes included all-cause hospital mortality and 28-day all-cause hospital mortality. The secondary outcomes included 7-day all-cause hospital mortality, 1-year all-cause mortality, and all-cause ICU mortality.Results: Among the 14304 records identified, 12 studies (71850 participants) were included. Meta-analysis showed inconclusive results on sex-based differences in hospital mortality (OR 0.95, 95% CI 0.55 to 1.64; very low-certainty evidence) and ICU mortality (OR 1.19, 95% CI 0.79 to 1.78; very low-certainty evidence). Meta-analysis found higher 28-day hospital mortality in the female group (OR 1.18, 95% CI 1.05 to 1.32; very low-certainty evidence). No studies reported on 7-day hospital mortality. A single study provided adjusted estimates on 1-year mortality reporting lower risk in the female group (OR 0.83 95% CI 0.68 to 0.98; low-certainty of evidence). The main reasons for assessing the certainty of evidence as very low were inconsistency and imprecision while downgrading to low-certainty was risk of bias and imprecision.Conclusions: The prognostic independent effect of sex on hospital mortality, 28-day hospital mortality, and ICU mortality for critically ill adults with sepsis is uncertain. Female sex may be associated with decreased 1-year mortality. No included studies reported on 7-day all-cause hospital mortality.

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Section: Studies Research and Characteristicsmentioning

confidence: 99%

Section: Studies Research and Characteristicsmentioning

confidence: 99%

Section: Studies Research and Characteristicsmentioning

confidence: 99%

Section: Primary Outcomesmentioning

confidence: 99%

Section: Primary Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: a systematic review and meta-analysis

Antequera

López‐Alcalde

Stallings

et al. 2020

Preprint

View full text Add to dashboard Cite

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Effect of Sex and Gender in Sepsis and Septic Shock: A Narrative Review

López

Lakbar

Léone

2021

Annual Update in Intensive Care and Emergency Medicine 2021

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Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study

2020

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Purpose: To compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU. Methods: We used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015. Results: Patients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded-54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen-40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles in 41.5% of cases compared to 30.0% in women (p < 0.001), and shorter time to antibiotics-65 (IQR 30-136) vs 87 min (IQR 39-172) (p = 0.0001). There was no significant difference between men and women regarding ICU nursing workload, mechanical ventilation or ICU length of stay. In severity-adjusted multivariable analysis, OR for women achieving a completed sepsis bundle, compared to men was 0.64 (CI 0.51-0.81). Thirty-day mortality was 25.0% for women and 23.1% for men (p = 0.24). Adjusted OR for female death was 1.28 (CI 1.00-1.64), but the increased mortality was not mediated by differential bundle completion. Conclusions: Women and men with severe sepsis or septic shock received differential care in the ED, but this did not explain higher odds of death in women.

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Association of Sex With Clinical Outcome in Critically Ill Sepsis Patients: A Retrospective Analysis of the Large Clinical Database MIMIC-III

Cited by 52 publications

References 29 publications

Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: a systematic review and meta-analysis

Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: a systematic review and meta-analysis

Effect of Sex and Gender in Sepsis and Septic Shock: A Narrative Review

Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study

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