Propensity-Score Analysis Reveals that Sex is Not a Prognostic Factor for Mortality in Intensive Care Unit-Admitted Patients with Septic Bacteremia

Ponce-Alonso, Manuel; Halperin, Ana; Rodríguez-Domínguez, Mario; Sánchez-Díaz, Ana Maria; Muriel, Alfonso; Zamora, Javier; Campo, Rosa del

doi:10.1016/j.ijid.2021.07.034

Cited by 5 publications

(5 citation statements)

References 40 publications

(39 reference statements)

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“…It has been found that sex could affect the manifestation and pathophysiology of many diseases ( 9 – 11 ). The impact of sex on outcomes in patients with sepsis has been widely investigated, yielding conflicting results ( 35 – 38 ). It has been found that women generally have more advantageous immunological responses compared to men by the effect of their sexual hormones ( 13 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…Future studies specifically designed to avoid sample bias are needed to validate this result. It is generally assumed that men had a higher incidence of sepsis, but the research about the relationship between sex and sepsis prognosis failed to reach consistent conclusions ( 35 – 38 ). Ponce-Alonso et al.…”

Section: Discussionmentioning

confidence: 99%

“…Ponce-Alonso et al. found that men with sepsis had worse clinical characteristics when admitted to the ICU, but sex had no influence on mortality ( 35 ). They compared their results with the last 15 years’ relevant published studies, and indicated that geographic location and case definitions were important confounders.…”

Section: Discussionmentioning

confidence: 99%

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No sex differences in the incidence, risk factors and clinical impact of acute kidney injury in critically ill patients with sepsis

Peng

Tang

et al. 2022

Front. Immunol.

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BackgroundSex-stratified medicine is an important aspect of precision medicine. We aimed to compare the incidence and risk factors of acute kidney injury (AKI) for critically ill men and women with sepsis. Furthermore, the short-term mortality was compared between men and women with sepsis associated acute kidney injury (SA-AKI).MethodThis was a retrospective study based on the Medical Information Mart for Intensive Care IV database. We used the multivariable logistic regression analysis to evaluate the independent effect of sex on the incidence of SA-AKI. We further applied three machine learning methods (decision tree, random forest and extreme gradient boosting) to screen for the risk factors associated with SA-AKI in the total, men and women groups. We finally compared the intensive care unit (ICU) and hospital mortality between men and women with SA-AKI using propensity score matching.ResultsA total of 6463 patients were included in our study, including 3673 men and 2790 women. The incidence of SA-AKI was 83.8% for men and 82.1% for women. After adjustment for confounders, no significant association was observed between sex and the incidence of SA-AKI (odds ratio (OR), 1.137; 95% confidence interval (CI), 0.949-1.361; p=0.163). The machine learning results revealed that body mass index, Oxford Acute Severity of Illness Score, diuretic, Acute Physiology Score III and age were the most important risk factors of SA-AKI, irrespective of sex. After propensity score matching, men had similar ICU and hospital mortality to women.ConclusionsThe incidence and associated risk factors of SA-AKI are similar between men and women, and men and women with SA-AKI experience comparable rates of ICU and hospital mortality. Therefore, sex-related effects may play a minor role in developing SA-AKI. Our study helps to contribute to the knowledge gap between sex and SA-AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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No sex differences in the incidence, risk factors and clinical impact of acute kidney injury in critically ill patients with sepsis

Peng

Tang

et al. 2022

Front. Immunol.

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“…Sex related differences in ICU admission, treatments offered, and outcome is becoming an increasing topic of interest. However, one Spanish study of 440 patients admitted to ICU with BSI found no differences in outcome by sex once confounding factors were adjusted for using propensity matched analysis [34]. The duration of treatment for patients with BSI admitted to ICUs has been an ongoing debate.…”

Section: Outcome Treatment and Costmentioning

confidence: 99%

Central line associated and primary bloodstream infections

Stewart,

Laupland,

Tabah

2023

Current Opinion in Critical Care

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Purpose of review Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU. Recent findings In critically ill patients, the pooled prevalence of primary and CA-BSI from contemporary studies was 19.7–40.7% and 26.4–37.3% of all BSIs, respectively. Failure to achieve source control (i.e., removal of catheter in CA-BSI) is associated with higher mortality. Higher severity scores and durations of ICU stay and catheter insertion are well established risk factors for CA-BSI. The use of prevention bundles when inserting a central venous line is able to reduce CA-BSI incidence from 4 to 1.6 episodes per 1000 central venous catheter days. Differential time-to-positivity of paired blood cultures may assist in the diagnosis of CA-BSI. Summary Primary BSI is frequently observed in ICU cohorts and has a poor effect on outcome. Surveillance for BSI among patients admitted to ICUs is fundamental to inform healthcare service delivery, design preventive approaches, to track resistance, and detect emerging pathogens.

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“…Nachtigall et al found a higher mortality risk in hospitalized male patients older than 60 years with COVID-19 [5]. In contrast, Ponce-Alonso et al found no effect of sex on mortality in patients with sepsis [6]. The effect of sex on patient treatment in emergency departments and ICU is measurable and was demonstrated by Valentin et al for therapeutic interventions and outcomes in the critically ill [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Female Patients with Pneumonia on Intensive Care Unit Are under Risk of Fatal Outcome

et al. 2022

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Background and Objectives: The impact of sex on mortality in patients with pneumonia requiring intensive care unit (ICU) treatment is still a controversial discussion, with studies providing heterogeneous results. The reasons for sex differences are widespread, including hormonal, immunologic and therapeutic approaches. This study’s aim was to evaluate sex-related differences in the mortality of ICU patients with pneumonia. Material and Methods: A prospective observational clinical trial was performed at Charité University Hospital in Berlin. Inclusion criteria were a diagnosis of pneumonia and a treatment period of over 24 h on ICU. A total of 436 mainly postoperative patients were included. Results: Out of 436 patients, 166 (38.1%) were female and 270 (61.9%) were male. Significant differences in their SOFA scores on admission, presence of immunosuppression and diagnosed cardiovascular disease were observed. Male patients were administered more types of antibiotics per day (p = 0.028) at significantly higher daily costs (in Euros) per applied anti-infective drug (p = 0.003). Mortalities on ICU were 34 (20.5%) in females and 39 (14.4%) in males (p = 0.113), before correcting for differences in patient characteristics using logistic regression analysis, and afterwards, the female sex showed an increased risk of ICU mortality with an OR of 1.775 (1.029–3.062, p = 0.039). Conclusions: ICU mortality was significantly higher in female patients with pneumonia. The identification of sex-specific differences is important to increase awareness among clinicians and allow resource allocation. The impact of sex on illness severity, sex differences in infectious diseases and the consequences on treatment need to be elucidated in the future.

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Propensity-Score Analysis Reveals that Sex is Not a Prognostic Factor for Mortality in Intensive Care Unit-Admitted Patients with Septic Bacteremia

Cited by 5 publications

References 40 publications

No sex differences in the incidence, risk factors and clinical impact of acute kidney injury in critically ill patients with sepsis

No sex differences in the incidence, risk factors and clinical impact of acute kidney injury in critically ill patients with sepsis

Central line associated and primary bloodstream infections

Female Patients with Pneumonia on Intensive Care Unit Are under Risk of Fatal Outcome

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