Contribution of Infection to Increased Mortality in Women After Cardiac Surgery

Rogers, Mary A.M.

doi:10.1001/.437

Cited by 11 publications

(7 citation statements)

References 26 publications

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“…However, some of the later studies have attributed this to the severity of illness and co-morbidities in women [39-41]. In one study, increased mortality in women after CABG was attributed to infection [42]. Get with the Guidelines-Coronary Artery Database investigators reported no overall difference in mortality between men and women with acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Association of gender with outcomes in critically ill patients

2012

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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.

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Section: Discussionmentioning

confidence: 99%

Association of gender with outcomes in critically ill patients

2012

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“…Are these differences due to biology or gender? Rogers et al (2006) studied 9,218 individuals (62.4% male, 37.6% female), followed for 100 days post-op (coronary artery bypass graft (CABG) surgery. Women were significantly more likely to die (16.1% versus 9.8%).…”

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confidence: 99%

Maintaining Integrity: Women and Treatment Seeking for the Symptoms of Potential Cardiac Illness

Turris

Johnson

2008

Qual Health Res

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Cardiac disease is the number one killer of Canadian women. Therapy is highly time-dependent, yet treatment-seeking delay persists. The purpose of this grounded theory study was to explore how women seeking treatment for the symptoms of potential cardiac illness interpreted their symptoms, made decisions about seeking treatment, and understood experiences of care in the emergency department. Data were drawn from 100 hours of naturalistic observation, in-depth interviews with 16 women who visited one of two urban emergency departments between June 2005 and June 2006, and three interviews with nurses. The basic social psychological process of maintaining integrity was identified, encompassing three distinct phases: "resisting disruption," "suspending agency," and "integrating experiences and knowledge." The findings suggest that in the face of a threat to life, women are first and foremost striving to maintain both the integrity of their sense of self and their ability to carry out role responsibilities.

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“…Although other studies 10 , 14 , 19 did not show the association between infection and in-hospital mortality among trauma, their results have limited generalizability because they were small and single-center studies. Infectious complications in trauma, similar to in postoperative patients 20 and patients with non-infectious internal diseases 21 , would have a worse impact on their prognosis.…”

Section: Discussionmentioning

confidence: 99%

The impact of infection complications after trauma differs according to trauma severity

Komori

Iriyama

Kainoh

et al. 2021

Sci Rep

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The impact of infection on the prognosis of trauma patients according to severity remains unclear. We assessed the impact of infection complications on in-hospital mortality among patients with trauma according to severity. This retrospective cohort study used a nationwide registry of trauma patients. Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15–29), or severe (ISS ≥ 30). Among the 150,948 patients in this study, 10,338 (6.8%) developed infections. Patients with infection had greater in-hospital mortality than patients without infection [1085 (10.5%) vs. 2898 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed between trauma patients with and without infection according to trauma severity [17.1% (95% CI 15.2–18.9%) vs. 2.9% (95% CI 2.7–3.1%), p < 0.01, in patients with mild trauma; 14.8% (95% CI 13.3–16.3%) vs. 8.4% (95% CI 7.9–8.8%), p < 0.01, in patients with moderate trauma; and 13.5% (95% CI 11.2–15.7%) vs. 13.7% (95% CI 12.4–14.9%), p = 0.86, in patients with severe trauma]. In conclusion, the effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

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Contribution of Infection to Increased Mortality in Women After Cardiac Surgery

Abstract: Background:Women have higher mortality rates after coronary artery bypass graft (CABG) surgery compared with men. Explanations for this sex difference are controversial. The objective of this study was to assess whether infection contributes to the increased risk of mortality in women.

Cited by 11 publications

References 26 publications

Association of gender with outcomes in critically ill patients

Association of gender with outcomes in critically ill patients

Maintaining Integrity: Women and Treatment Seeking for the Symptoms of Potential Cardiac Illness

The impact of infection complications after trauma differs according to trauma severity

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