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Shehata AH, Anter AF, Mohamed Naguib Abdel Hafez S, Rn Ibrahim A, Kamel ES, Ahmed ASF. Pioglitazone ameliorates sepsis-associated encephalopathy through SIRT1 signaling pathway. Int Immunopharmacol 2024; 139:112757. [PMID: 39067401 DOI: 10.1016/j.intimp.2024.112757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
Sepsis is a severe immune response to an infection. It is associated with multiple organ dysfunction syndrome (MODs) along with systemic and neuronal inflammatory response. This study focused on the acute neurologic dysfunction associated with sepsis by exploring the role of PPARγ/SIRT1 pathway against sepsis. We studied the role of this axis in ameliorating sepsis-associated encephalopathy (SAE) and its linked neurobehavioral disorders by using pioglitazone (PIO). This PPARγ agonist showed neuroprotective actions in neuroinflammatory disorders. Sepsis was induced in mice by LPS (10 mg/kg). Survival rate and MODs were assessed. Furthermore, behavioral deficits, cerebral oxidative, inflammatory, and apoptotic markers, and the cerebral expression level of SIRT1 were determined. In this study, we observed that PIO attenuated sepsis-induced cerebral injury. PIO significantly enhanced survival rate, attenuated MODs, and systemic inflammatory response in septic mice. PIO also promoted cerebral SIRT1 expression and reduced cerebral activation of microglia, oxidative stress, HMGB, iNOS, NLRP3 and caspase-3 along with an obvious improvement in behavioral deficits and cerebral pathological damage induced by LPS. Most of the neuroprotective effects of PIO were abolished by EX-527, a SIRT1 inhibitor. These results highlight that the neuroprotective effect of PIO in SAE is mainly SIRT1-dependent.
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Affiliation(s)
- Alaa H Shehata
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Aliaa F Anter
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt
| | | | - Ahmed Rn Ibrahim
- Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, Egypt; Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Eman S Kamel
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, USA; Department of Clinical Pharmacy, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Al-Shaimaa F Ahmed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt.
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2
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Min SY, Yong HJ, Kim D. Sex or gender differences in treatment outcomes of sepsis and septic shock. Acute Crit Care 2024; 39:207-213. [PMID: 38863351 PMCID: PMC11167424 DOI: 10.4266/acc.2024.00591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.
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Affiliation(s)
- Seung Yeon Min
- Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Ho Jin Yong
- Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Dohhyung Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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3
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Ahn S, Jin BY, Lee S, Kim S, Moon S, Cho H, Han KS, Jo YH, Kim K, Shin J, Suh GJ, Kwon WY, Shin TG, Choi HS, Choi S, Park YS, Chung SP, Kim WY, Ahn HJ, Lim TH, Choi SH, Park JH. Sex differences in in-hospital management in patients with sepsis and septic shock: a prospective multicenter observational study. Sci Rep 2024; 14:4900. [PMID: 38418899 PMCID: PMC10901798 DOI: 10.1038/s41598-024-55421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
Sex differences in the in-hospital management of sepsis exist. Previous studies either included patients with sepsis that was defined using previous definitions of sepsis or evaluated the 3-h bundle therapy. Therefore, this study sought to assess sex differences in 1-h bundle therapy and in-hospital management among patients with sepsis and septic shock, defined according to the Sepsis-3 definitions. This observational study used data from Korean Shock Society (KoSS) registry, a prospective multicenter sepsis registry. Adult patients with sepsis between June 2018 and December 2021 were included in this study. The primary outcome was adherence to 1-h bundle therapy. Propensity score matching (PSM) and multivariable logistic regression analyses were performed. Among 3264 patients with sepsis, 3129 were analyzed. PSM yielded 2380 matched patients (1190 men and 1190 women). After PSM, 1-h bundle therapy was performed less frequently in women than in men (13.0% vs. 19.2%; p < 0.001). Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently in women than in men (25.4% vs. 31.6%, p < 0.001), whereas adequate fluid resuscitation was performed more frequently in women than in men (96.8% vs. 95.0%, p = 0.029). In multivariable logistic regression analysis, 1-h bundle therapy was performed less frequently in women than in men [adjusted odds ratio (aOR) 1.559; 95% confidence interval (CI) 1.245-1.951; p < 0.001] after adjustment. Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently to women than men (aOR 1.339, 95% CI 1.118-1.605; p = 0.002), whereas adequate fluid resuscitation was performed more frequently for women than for men (aOR 0.629, 95% CI 0.413-0.959; p = 0.031). Invasive arterial blood pressure monitoring was performed less frequently in women than in men. Resuscitation fluid, vasopressor, steroid, central-line insertion, ICU admission, length of stay in the emergency department, mechanical ventilator use, and renal replacement therapy use were comparable for both the sexes. Among patients with sepsis and septic shock, 1-h bundle therapy was performed less frequently in women than in men. Continuous efforts are required to increase adherence to the 1-h bundle therapy and to decrease sex differences in the in-hospital management of patients with sepsis and septic shock.
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Affiliation(s)
- Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Republic of Korea
| | - Bo-Yeong Jin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Republic of Korea
| | - Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Republic of Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han Sung Choi
- Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sangchun Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Republic of Korea.
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Evans C, Wiley Z. Demographic and Geographic Inequities in Antimicrobial Use and Prescribing. Infect Dis Clin North Am 2023; 37:715-728. [PMID: 37567855 DOI: 10.1016/j.idc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Little is known about how social determinants of health may impact antimicrobial prescribing among racial and ethnic minority populations, different age groups and genders, and across geographic regions. The factors that influence antimicrobial prescribing are complex, but evidence suggests that demographic and socioeconomic factors do influence prescribing patterns. This review describes the inequities observed in antimicrobial use and prescribing that have been heretofore published, with a focus on differences observed by race and ethnicity, age, gender, and geographic region of the United States.
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Affiliation(s)
- Christopher Evans
- Healthcare-Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health, Andrew Johnson Tower, 3.419C 710 James Robertson Parkway, Nashville, TN 37243, USA.
| | - Zanthia Wiley
- Emory Division of Infectious Diseases, Emory University Hospital Midtown, 550 Peachtree Street NE, Atlanta, GA 30308, USA
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5
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Ko RE, Kang D, Cho J, Na SJ, Chung CR, Lim SY, Lee YJ, Park S, Oh DK, Lee SY, Park MH, Lee H, Lim CM, Suh GY. Influence of gender on age-associated in-hospital mortality in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study. Crit Care 2023; 27:229. [PMID: 37303037 DOI: 10.1186/s13054-023-04515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have shown conflicting evidence. This study aimed to investigate the effect of gender on in-hospital mortality due to sepsis according to age group. METHODS This study used data from the Korean Sepsis Alliance, an ongoing nationwide prospective multicenter cohort from 19 participating hospitals in South Korea. All adult patients diagnosed with sepsis in the emergency departments of the participating hospitals between September 2019 and December 2021 were included in the analysis. Clinical characteristics and outcomes were compared between male and female. Eligible patients were stratified by age into 19-50 years, 50-80 years, and ≥ 80 years old individuals. RESULTS During the study period, 6442 patients were included in the analysis, and 3650 (56.7%) were male. The adjusted odds ratio (OR) [95% confidence interval (CI)] for in-hospital mortality for male compared with female was 1.15 (95% CI = 1.02-1.29). Interestingly, in the age 19-50 group, the risk of in-hospital mortality for males was significantly lower than that of females [0.57 (95% CI = 0.35-0.93)]. For female, the risk of death remained relatively stable until around age 80 (P for linearity = 0.77), while in males, there was a linear increase in the risk of in-hospital death until around age 80 (P for linearity < 0.01). Respiratory infection (53.8% vs. 37.4%, p < 0.01) was more common in male, whereas urinary tract infection (14.7% vs. 29.8%, p < 0.01) was more common in female. For respiratory infection, male had significantly lower in-hospital mortality than female in the age 19-50 groups (adjusted OR = 0.29, 95% CI = 0.12-0.69). CONCLUSIONS Gender may influence age-associated sepsis outcomes. Further studies are needed to replicate our findings and fully understand the interaction of gender and age on the outcomes of patients with sepsis.
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Affiliation(s)
- Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Lim
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeon Joo Lee
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Dong Kyu Oh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Yeon Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Hyeon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Haein Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea.
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Mewes C, Runzheimer J, Böhnke C, Büttner B, Hinz J, Quintel M, Mansur A. Association of Sex Differences with Mortality and Organ Dysfunction in Patients with Sepsis and Septic Shock. J Pers Med 2023; 13:jpm13050836. [PMID: 37241006 DOI: 10.3390/jpm13050836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Despite recent advances in the clinical management and understanding of sepsis and septic shock, these complex clinical syndromes continue to have high mortality rates. The effect of sex on these diseases' mortality, clinical presentation and morbidity remains controversial. This study aimed to investigate the association of sex with mortality and organ dysfunction in patients with sepsis and septic shock. METHODS Prospectively enrolled patients with clinically defined sepsis and septic shock in three intensive care units at University Medical Center Göttingen, Germany, were investigated. The primary outcomes were 28- and 90-day mortality, while the secondary endpoints included the evaluation of organ dysfunction as measured by clinical scores and laboratory parameters. RESULTS A total of 737 septic patients were enrolled, including 373 in septic shock, 484 males, and 253 females. No significant differences in 28- and 90-day mortality were observed in the cohort. However, men with sepsis had significantly higher SOFA scores, SOFA respiratory and renal subscores, bilirubin and creatinine values, and lower weight-adapted urine outputs, indicating higher organ dysfunction compared to women. CONCLUSIONS Our findings revealed notable differences in organ dysfunction between male and female patients, with males exhibiting more pronounced dysfunction across multiple clinical indicators. These results highlight the potential influence of sex on sepsis disease severity and suggest the need for tailored approaches in sepsis management according to patient sex.
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Affiliation(s)
- Caspar Mewes
- Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany
- Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Julius Runzheimer
- Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Carolin Böhnke
- Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Benedikt Büttner
- Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - José Hinz
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Region Hannover, 30459 Hannover, Germany
| | - Michael Quintel
- Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany
- Department of Anesthesiology, Asklepios Hospitals Schildautal, 38723 Seesen, Germany
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Lakbar I, Einav S, Lalevée N, Martin-Loeches I, Pastene B, Leone M. Interactions between Gender and Sepsis—Implications for the Future. Microorganisms 2023; 11:microorganisms11030746. [PMID: 36985319 PMCID: PMC10058943 DOI: 10.3390/microorganisms11030746] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Sex and gender dimorphisms are found in a large variety of diseases, including sepsis and septic shock which are more prevalent in men than in women. Animal models show that the host response to pathogens differs in females and males. This difference is partially explained by sex polarization of the intracellular pathways responding to pathogen–cell receptor interactions. Sex hormones seem to be responsible for this polarization, although other factors, such as chromosomal effects, have yet to be investigated. In brief, females are less susceptible to sepsis and seem to recover more effectively than males. Clinical observations produce more nuanced findings, but men consistently have a higher incidence of sepsis, and some reports also claim higher mortality rates. However, variables other than hormonal differences complicate the interaction between sex and sepsis, including comorbidities as well as social and cultural differences between men and women. Conflicting data have also been reported regarding sepsis-attributable mortality rates among pregnant women, compared with non-pregnant females. We believe that unraveling sex differences in the host response to sepsis and its treatment could be the first step in personalized, phenotype-based management of patients with sepsis and septic shock.
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Affiliation(s)
- Ines Lakbar
- Department of Anesthesiology and Intensive Care Unit, Assistance Publique Hôpitaux Universitaires de Marseille, Aix-Marseille University, Hospital Nord, 13015 Marseille, France
- CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Aix-Marseille University, 13015 Marseille, France
| | - Sharon Einav
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 23456, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 23456, Israel
| | - Nathalie Lalevée
- INSERM, INRAE, Centre for Nutrition and Cardiovascular Disease (C2VN), Aix-Marseille University, 13005 Marseille, France
| | - Ignacio Martin-Loeches
- Intensive Care Unit, Trinity Centre for Health Science HRB-Wellcome Trust, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Bruno Pastene
- Department of Anesthesiology and Intensive Care Unit, Assistance Publique Hôpitaux Universitaires de Marseille, Aix-Marseille University, Hospital Nord, 13015 Marseille, France
- INSERM, INRAE, Centre for Nutrition and Cardiovascular Disease (C2VN), Aix-Marseille University, 13005 Marseille, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Assistance Publique Hôpitaux Universitaires de Marseille, Aix-Marseille University, Hospital Nord, 13015 Marseille, France
- INSERM, INRAE, Centre for Nutrition and Cardiovascular Disease (C2VN), Aix-Marseille University, 13005 Marseille, France
- Correspondence:
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8
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Wanrooij VHM, Cobussen M, Stoffers J, Buijs J, Bergmans DCJJ, Zelis N, Stassen PM. Sex differences in clinical presentation and mortality in emergency department patients with sepsis. Ann Med 2023; 55:2244873. [PMID: 37566727 PMCID: PMC10424597 DOI: 10.1080/07853890.2023.2244873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There is growing awareness that sex differences are associated with different patient outcomes in a variety of diseases. Studies investigating the effect of patient sex on sepsis-related mortality remain inconclusive and mainly focus on patients with severe sepsis and septic shock in the intensive care unit. We therefore investigated the association between patient sex and both clinical presentation and 30-day mortality in patients with the whole spectrum of sepsis severity presenting to the emergency department (ED) who were admitted to the hospital. MATERIALS AND METHODS In our multi-centre cohort study, we retrospectively investigated adult medical patients with sepsis in the ED. Multivariable analysis was used to evaluate the association between patient sex and all-cause 30-day mortality. RESULTS Of 2065 patients included, 47.6% were female. Female patients had significantly less comorbidities, lower Sequential Organ Failure Assessment score and abbreviated Mortality Emergency Department Sepsis score, and presented less frequently with thrombocytopenia and fever, compared to males. For both sexes, respiratory tract infections were predominant while female patients more often had urinary tract infections. Females showed lower 30-day mortality (10.1% vs. 13.6%; p = .016), and in-hospital mortality (8.0% vs. 11.1%; p = .02) compared to males. However, a multivariable logistic regression model showed that patient sex was not an independent predictor of 30-day mortality (OR 0.90; 95% CI 0.67-1.22; p = .51). CONCLUSIONS Females with sepsis presenting to the ED had fewer comorbidities, lower disease severity, less often thrombocytopenia and fever and were more likely to have a urinary tract infection. Females had a lower in-hospital and 30-day mortality compared to males, but sex was not an independent predictor of 30-day mortality. The lower mortality in female patients may be explained by differences in comorbidity and clinical presentation compared to male patients.KEY MESSAGESOnly limited data exist on sex differences in sepsis patients presenting to the emergency department with the whole spectrum of sepsis severity.Female sepsis patients had a lower incidence of comorbidities, less disease severity and a different source of infection, which explains the lower 30-day mortality we found in female patients compared to male patients.We found that sex was not an independent predictor of 30-day mortality; however, the study was probably underpowered to evaluate this outcome definitively.
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Affiliation(s)
- Vera H. M. Wanrooij
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maarten Cobussen
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- School of CARIM, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Judith Stoffers
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Dennis C. J. J. Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Noortje Zelis
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Patricia M. Stassen
- School of CARIM, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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10
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Malnoske ML, Quill CM, Barwise AK, Pietropaoli AP. Disparities in Lung-Protective Ventilation in the United States. Cureus 2022; 14:e29834. [PMID: 36337793 PMCID: PMC9625078 DOI: 10.7759/cureus.29834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 06/16/2023] Open
Abstract
Background The objective of our study was to determine whether disparities exist in the use of lung-protective ventilation for critically ill mechanically ventilated patients in the United States based on gender, race/ethnicity, or insurance status. Methods This was a secondary data analysis of a prospective multicenter cohort study conducted from 2010 to 2012. The outcome of interest was the proportion of patients receiving tidal volume > 8 mL/kg predicted body weight (PBW). Results There were 1,595 patients in our primary analysis (710 women, 885 men). Women were more likely to receive tidal volumes > 8 mL/kg PBW than men (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 2.67-4.40), a finding largely but not completely explained by gender differences in height. The underinsured were significantly more likely to receive tidal volume > 8 mL/kg PBW than the insured in multivariable analysis (OR = 1.54, 95% CI = 1.16-2.04). The prescription of > 8 mL/kg PBW tidal volume did not differ by racial or ethnic categories. Conclusions In this prospective nationwide cohort of critically ill mechanically ventilated patients, women and the underinsured were less likely than their comparators to receive lung-protective ventilation, with no apparent differences based on race/ethnicity alone.
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Affiliation(s)
- Michelle L Malnoske
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA
| | - Caroline M Quill
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Anthony P Pietropaoli
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA
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11
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Salameh B, Aboamash AEM. Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221115265. [PMID: 35932110 PMCID: PMC9364222 DOI: 10.1177/00469580221115265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sepsis is a widespread problem that can create clinical and economic
difficulties. This study aimed to determine the knowledge, attitudes, practices,
and barriers related to the sepsis and sepsis management among emergency nurses
and physicians. Data was collected using a self-questionnaire completed by the
participating nurses and physicians (n = 243), with a 61% response rate. The
study found that both emergency nurses and physicians had poor-to-moderate
levels of sepsis knowledge, with emergency physicians having better attitudes
regarding sepsis and sepsis management than emergency nurses. However, moderate
knowledge levels of sepsis practice and management were shown among both nurses
and physicians. It is evident that for emergency nurses and physicians, the
biggest barrier to providing quality care to patients with sepsis is the lack of
monitoring equipment. Both nurses and physicians need consistent sepsis
management information provided by continual education programs. Development of
an approved protocol can improve nurses’ knowledge, attitudes, and
practices.
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12
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Goswami DG, Walker WE. Aged IRF3-KO Mice are Protected from Sepsis. J Inflamm Res 2021; 14:5757-5767. [PMID: 34764669 PMCID: PMC8573150 DOI: 10.2147/jir.s335203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Sepsis is a leading cause of hospital admissions and deaths. Older adults (>65 years) are particularly susceptible to sepsis and experience higher morbidity and mortality rates than younger people. We previously showed that interferon regulatory factor 3 (IRF3) contributes to sepsis pathogenesis in young mice subject to cecal ligation and puncture (CLP). In this study, we investigated if IRF3 contributes to sepsis in the context of aging. Methods Sepsis was induced in aged wild-type (WT) and IRF3-knock-out (KO) mice, using a clinically-relevant CLP-sepsis model including fluids and antibiotics. Animal survival, disease score and hypothermia were evaluated as indicators of sepsis pathogenesis. Serum cytokines and serum enzymes indicative of organ damage were also measured. Results Aged WT mice were highly susceptible to sepsis (90% mortality). In comparison, aged IRF3-KO mice were significantly protected (20% mortality). Aged IRF3-KO mice showed a lower disease score and reduced hypothermia following CLP, compared to WT mice. Serum cytokines interleukin (IL)-6, IL-12/23p40 and macrophage chemoattractant protein (MCP)-1, and creatinine kinase (CK) were lower in aged IRF3-KO septic mice compared to WT counterparts. Aged male mice were found to be more susceptible to sepsis compared to females. Female mice, however, produced higher levels of serum cytokines and CK. Conclusion These results demonstrate that IRF3 plays a detrimental role in sepsis in aged mice and highlight the impact of biological sex.
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Affiliation(s)
- Dinesh G Goswami
- Center of Emphasis in Infectious Diseases, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Wendy E Walker
- Center of Emphasis in Infectious Diseases, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.,Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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13
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Zhou X, Zeng N, Liu P, Liu Z, Duan M. Sex Differences in In-hospital Mortality of Patients With Septic Shock: An Observational Study Based on Data Analysis From a Cover Sheet of Medical Records in Beijing. Front Med (Lausanne) 2021; 8:733410. [PMID: 34708054 PMCID: PMC8542919 DOI: 10.3389/fmed.2021.733410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The goal of our study was to evaluate the association of sex and in-hospital mortality in patients with septic shock in Beijing, China. Materials and Methods: We analyzed 3,643 adult patients with septic shock from January 1, 2019, to Dec 31, 2019, in all secondary and tertiary hospitals in Beijing. Study data were retrospectively extracted from the Quality Control Center of Beijing Municipal Health Commission. Results: There were 2,345 (64.37%) male and 1,298 (35.63%) female patients. Compared to male patients, female patients with septic shock had a higher in-hospital mortality rate (55.54 vs. 49.29%, p < 0.01). The median length of hospitalization stay for male patients was 22.71 days, while that for female patients was 19.72 days (p > 0.01). Male patients had a higher prevalence of pulmonary infection (68.8 vs. 31.2%, p < 0.01). The B values of sex in univariate and multivariate logistic regression were −0.251 and −0.312, respectively. Men had a lower likelihood of hospital mortality than women (OR = 0.732, 95% CI = 0.635–0.844, p = 0.000). Conclusions: Female patients with septic shock had a higher risk of dying in the hospital than male patients.
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Affiliation(s)
- Xiao Zhou
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zeng
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhuang Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Antequera A, Lopez-Alcalde J, Stallings E, Muriel A, Fernández Félix B, Del Campo R, Ponce-Alonso M, Fidalgo P, Halperin AV, Madrid-Pascual O, Álvarez-Díaz N, Solà I, Gordo F, Urrutia G, Zamora J. Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis. BMJ Open 2021; 11:e048982. [PMID: 34551945 PMCID: PMC8461281 DOI: 10.1136/bmjopen-2021-048982] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess the role of sex as an independent prognostic factor for mortality in patients with sepsis admitted to intensive care units (ICUs). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, Web of Science, ClinicalTrials.gov and the WHO Clinical Trials Registry from inception to 17 July 2020. STUDY SELECTION Studies evaluating independent associations between sex and mortality in critically ill adults with sepsis controlling for at least one of five core covariate domains prespecified following a literature search and consensus among experts. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted and assessed the risk of bias using Quality In Prognosis Studies tool. Meta-analysis was performed by pooling adjusted estimates. The Grades of Recommendations, Assessment, Development and Evaluation approach was used to rate the certainty of evidence. RESULTS From 14 304 records, 13 studies (80 520 participants) were included. Meta-analysis did not find sex-based differences in all-cause hospital mortality (OR 1.02, 95% CI 0.79 to 1.32; very low-certainty evidence) and all-cause ICU mortality (OR 1.19, 95% CI 0.79 to 1.78; very low-certainty evidence). However, females presented higher 28-day all-cause mortality (OR 1.18, 95% CI 1.05 to 1.32; very low-certainty evidence) and lower 1-year all-cause mortality (OR 0.83, 95% CI 0.68 to 0.98; low-certainty evidence). There was a moderate risk of bias in the domain adjustment for other prognostic factors in six studies, and the certainty of evidence was further affected by inconsistency and imprecision. CONCLUSION The prognostic independent effect of sex on all-cause hospital mortality, 28-day all-cause mortality and all-cause ICU mortality for critically ill adults with sepsis was uncertain. Female sex may be associated with decreased 1-year all-cause mortality. PROSPERO REGISTRATION NUMBER CRD42019145054.
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Affiliation(s)
- Alba Antequera
- Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Jesus Lopez-Alcalde
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich, Zurich, Switzerland
- CIBERESP, Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain
- CIBERESP, Madrid, Spain
| | - Alfonso Muriel
- Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain
- CIBERESP, Madrid, Spain
- Department of Nursing and Physiotherapy, Universidad de Alcala de Henares, Alcala de Henares, Spain
| | - Borja Fernández Félix
- Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain
- CIBERESP, Madrid, Spain
| | - Rosa Del Campo
- Department of Microbiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Manuel Ponce-Alonso
- Department of Microbiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Pilar Fidalgo
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Department of Internal Medicine, Hospital Universitario del Henares, Coslada, Spain
| | | | | | | | - Ivan Solà
- Iberoamerican Cochrane Centre, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
- CIBERESP, Barcelona, Spain
| | - Federico Gordo
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Department of Intensive Care, Hospital Universitario del Henares, Coslada, Spain
| | - Gerard Urrutia
- Iberoamerican Cochrane Centre, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
- CIBERESP, Barcelona, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain
- CIBERESP, Madrid, Spain
- Institute of metabolism and systems research, University of Birmingham, Birmingham, UK
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Trent SA, George N, Havranek EP, Ginde AA, Haukoos JS. Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care. Acad Emerg Med 2021; 28:1051-1060. [PMID: 33599040 DOI: 10.1111/acem.14235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. Our objective was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. METHODS We conducted a preplanned secondary analysis of data from a multicenter retrospective observational study evaluating variation in ED adherence to five core evidence-based treatment guidelines including aspirin for acute coronary syndrome, door-to-balloon time for acute ST-elevation myocardial infarction, systemic thrombolysis for acute ischemic stroke, antibiotic selection for inpatient pneumonia, and early management of severe sepsis/septic shock. This study was performed at six hospitals in Colorado with heterogeneous and diverse practice environments. Hierarchical generalized linear modeling was used to estimate adjusted associations between ED adherence and patient sex and race/ethnicity while controlling for other patient, physician, and environmental factors that could confound this association. RESULTS A total of 1,880 patients were included in the study with a median (IQR) age of 62 (51-74) years. Males and non-Hispanic whites comprised 59% and 71% of the cohort, respectively. While unadjusted differences were identified, our adjusted analyses found no significant association between ED guideline adherence and sex or race/ethnicity. Patients who did not receive guideline adherent care in the ED were significantly more likely to die while in the hospital (odds ratio = 2.0, 95% confidence interval = 1.3 to 3.2). CONCLUSIONS Longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care. When providers know their care is being monitored and reported, their implicit biases may be less likely to impact care.
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Affiliation(s)
- Stacy A. Trent
- Department of Emergency Medicine Denver Health Medical Center Denver Colorado USA
- Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
| | - Nigel George
- Department of Emergency Medicine Piedmont Athens Regional Medical Center Athens Georgia USA
| | - Edward P. Havranek
- Department of Medicine Denver Health Medical Center Denver Colorado USA
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado USA
| | - Adit A. Ginde
- Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
| | - Jason S. Haukoos
- Department of Emergency Medicine Denver Health Medical Center Denver Colorado USA
- Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
- Department of Epidemiology Colorado School of Public Health Aurora Colorado USA
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16
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Ponce-Alonso M, Fernández-Félix BM, Halperin A, Rodríguez-Domínguez M, Sánchez-Díaz AM, Cantón R, Muriel A, Zamora J, Del Campo R. Propensity-Score Analysis Reveals that Sex is Not a Prognostic Factor for Mortality in Intensive Care Unit-Admitted Patients with Septic Bacteremia. Int J Infect Dis 2021; 110:36-44. [PMID: 34274507 DOI: 10.1016/j.ijid.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Men have been considered to have a higher incidence of infectious diseases, with controversy over the possibility that sex could influence the prognosis of the infection. This study aimed to explore this assumption in patients admitted to the intensive care unit (ICU) with septic bacteremia. METHODS A retrospective analysis (2006-2017) of septic patients with microbiologically confirmed bacteremia (n=440) was performed. Risk of ICU and in-hospital mortality in males versus females was compared by univariate analysis and a propensity score analysis integrating their clinical characteristics. RESULTS Sepsis more frequently occurred in males (80.2% vs 76.1%) as well as in-hospital (48.0% vs 41.3%) and ICU (39.9% vs 36.5%) mortality. Univariate analyses showed that males had a higher Charlson comorbidity index and worse McCabe prognostic score. However, the propensity score in 296 matched patients demonstrated that females had higher risk of both ICU (OR 1.39; 95% CI 0.89-2.19) and in-hospital mortality (OR 1.18; 95% CI 0.77-1.83), but without statistical significance. CONCLUSION Males with sepsis had worse clinical characteristics when admitted to the ICU, but sex had no influence on mortality. These data contribute to helping reduce the sex-dependent gap present in healthcare provision.
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Affiliation(s)
- Manuel Ponce-Alonso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Borja M Fernández-Félix
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Halperin
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Mario Rodríguez-Domínguez
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana M Sánchez-Díaz
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Alfonso Muriel
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Zamora
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.
| | - Rosa Del Campo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; University Alfonso X El Sabio, Villanueva de la Cañada, Madrid, Spain.
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Abstract
OBJECTIVES Sepsis is a life-threatening condition and is one of the leading causes of death in the United States. The burden of sepsis-related mortality in the United States in recent years is not well characterized. We sought to describe sepsis-related mortality rates and mortality trends in the United States from 2005 to 2018. DESIGN Retrospective population-based study. SETTING We used the Multiple Cause of Death Database available through the Centers for Disease Control and Prevention website. PATIENTS Decedents with sepsis-related deaths were identified using previously validated International Classification of Diseases codes. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS From 2005 to 2018, 6.7% of decedents had a diagnosis of sepsis. The overall sepsis-related mortality rates remained stable in both males (57 deaths per 100,000) and females (45.1 deaths per 100,000) during this period. Compared with Whites, the sepsis-related mortality rates were higher in Blacks (rate ratio = 1.78), Native Americans (rate ratio = 1.43), and Hispanics (rate ratio = 1.04) and were lower in Asians (rate ratio = 0.73). Sepsis-related mortality rates declined in Blacks, Hispanics, and Asians but increased in Whites and Native Americans. The majority of sepsis-related deaths occurred in the hospital. The percentage of deaths in the nursing home decreased, whereas deaths occurring at home and hospice increased. CONCLUSIONS From 2005 to 2018, the overall sepsis-related mortality rates were stable, but there were significant racial and gender disparities in mortality trends. Further research is needed to evaluate the genetic and environmental contributors to these differences.
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18
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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. Shock 2020; 52:146-151. [PMID: 30138298 PMCID: PMC6687414 DOI: 10.1097/shk.0000000000001253] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The objective of our study was to explore the association between sex and clinical outcome in sepsis patients in a large, diverse population. MATERIALS AND METHODS We analyzed 6,134 adult patients with sepsis from the critical care units of Beth Israel Deaconess Medical Center between 2001 and 2012. Study data were retrospectively extracted from Medical Information Mart for Intensive Care-III, a multiparameter intensive care database. RESULTS There were 2,677 (43.6%) female and 3,457 (56.4%) male patients. Compared with female patients, male patients with sepsis had a higher 1-year mortality rate (55.6% vs. 51.4%, P = 0.001), and so did the 90-day mortality rate (45.1% vs. 42.1%, P = 0.018). 33.8% of male and 31.3% of female patients with sepsis died during hospitalization (P = 0.041). The median length of hospitalization and intensive care unit (ICU) stay for male patients was 19.54 and 7.54 days, while that for female patients was 16.49 and 6.75 days (P < 0.001, P = 0.002, respectively). Male patients were more likely to require dialysis therapy (P = 0.109), ventilation support (P = 0.012) and more vasoactive agents (dopamine P = 0.113, norepinephrine P = 0.016, and epinephrine P = 0.093) during the ICU period than female patients. Our Cox proportional hazard regression model confirmed that the risk of death within 1 year of ICU admission in male patients is 1.083 times that in female. CONCLUSION Female patients with sepsis have better clinical outcomes than male patients in terms of mortality and length of hospitalization and ICU stay.
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The Patient's Gender Influencing the Accuracy of Diagnosis and Proposed Sepsis Treatment in Constructed Cases. Emerg Med Int 2020; 2020:4823095. [PMID: 32774922 PMCID: PMC7391101 DOI: 10.1155/2020/4823095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 12/05/2022] Open
Abstract
Background Male sex is an independent risk factor for sepsis development. In addition to immunological gender differences, women less often receive sepsis treatment once diagnosed. Gender differences have also been described in other medical conditions, such as acute coronary syndrome. Aim To study whether the gender of patients influenced physicians' tendency to suspect sepsis and propose correct initial sepsis treatment in constructed cases. Method Four cases were constructed to fulfil the sepsis-3 criteria as well as raise clinical suspicions of other common medical differential diagnoses. Two of the cases were drafted in two versions, only differing in the gender of the patient. The two versions were randomly distributed to all clinical physicians in a medical region in Sweden. The responding physicians were asked to state the three most important diagnoses and the three most important initial treatments for each case. If sepsis were among the stated diagnoses together with fluids and antibiotics, the case was considered as correctly identified and initially treated sepsis. Results 120 hospital physicians answered the cases. In the case the patient was a female, the respondents correctly identified and treated sepsis significantly more often than if the patient was of the male sex (Case 1: 12/58 vs 2/62, p < 0.01 and Case 2: 25/62 vs 13/58, p < 0.05). Conclusion A low proportion of Swedish physicians identified and proposed treatment for sepsis in four constructed cases. In the case the patient strongly mimicked other diagnoses common in the male sex, the male cases were less often correctly identified and treated for sepsis.
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Incidence and Outcomes of Sepsis in Korea: A Nationwide Cohort Study From 2007 to 2016. Crit Care Med 2020; 47:e993-e998. [PMID: 31569138 DOI: 10.1097/ccm.0000000000004041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study aimed to estimate the incidence and clinical outcomes of sepsis in Korea from 2007 to 2016. DESIGN Retrospective observational study. SETTING Nationwide study with population-based healthcare reimbursement claims database. PATIENTS Using data from the National Health Insurance Service of Korea, patients who were hospitalized with a diagnosis of sepsis from 2007 to 2016 were analyzed. The incidence of sepsis was calculated using mid-year census population and analyzed according to year, age, and sex. The Elixhauser Comorbidity Index score was calculated to adjust for the impact of comorbidities on clinical outcome. In-hospital mortality, hospital length of stay, ICU admission rates, and risk factors for in-hospital mortality were also analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The incidence of sepsis increased from 173.8 per 100,000 population in 2007 to 233.6 per 100,000 population in 2016. In-hospital mortality decreased from 30.9% in 2007 to 22.6% in 2016 (p < 0.0001). From 2007 to 2016, hospital length of stay and ICU admission rates associated with sepsis decreased from 26.0 ± 33.5 days to 21.3 ± 24.4 days (p < 0.0001) and from 16.2% to 12.7% (p < 0.0001), respectively. Male sex, age greater than 50 years, Elixhauser Comorbidity Index greater than 10, and mechanical ventilation were identified as risk factors for in-hospital mortality after adjusting for baseline characteristics. CONCLUSIONS The incidence of sepsis in Korea increased from 2007 to 2016, while the associated in-hospital mortality, hospital length of stay, and ICU admission rates decreased.
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Barbagelata E, Cillóniz C, Dominedò C, Torres A, Nicolini A, Solidoro P. Gender differences in community-acquired pneumonia. Minerva Med 2020; 111:153-165. [PMID: 32166931 DOI: 10.23736/s0026-4806.20.06448-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is the most common type of lower respiratory tract infection and a major cause of morbidity and mortality in adults worldwide. Sex and gender play an active role in the incidence and outcomes of major infectious diseases, including CAP. EVIDENCE ACQUISITION We searched the following electronic databases from January 2001 to December 2018: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), Cochrane Database of Systematic Reviews and ACP Journal Club database. EVIDENCE SYNTHESIS Several studies have reported higher male susceptibility to pulmonary infections and higher risk of death due to sepsis. Biological differences (e.g. hormonal cycles and cellular immune-mediated responses) together with cultural, behavioral and socio-economic differences are important determinants of the course and outcome of CAP. However, gender-related bias in the provision of care and use of hospital resources has been reported among women, resulting in delayed hospital admission and consequently necessary care. CONCLUSIONS CAP is more severe in males than in females, leading to higher mortality in males, especially in older age. To identify gender differences in CAP can guide patient's prognostication and management.
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Affiliation(s)
- Elena Barbagelata
- Department of Internal Medicine, General Hospital, Sestri Levante, Genoa, Italy
| | - Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Antonello Nicolini
- Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy -
| | - Paolo Solidoro
- Unit of Pneumology U, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
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22
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Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study. Intensive Care Med 2020; 46:727-736. [PMID: 31974918 PMCID: PMC7103003 DOI: 10.1007/s00134-019-05910-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/19/2019] [Indexed: 01/06/2023]
Abstract
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. Electronic supplementary material The online version of this article (10.1007/s00134-019-05910-9) contains supplementary material, which is available to authorized users.
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Beauchamp GA, McGregor AJ, Choo EK, Safdar B, Rayl Greenberg M. Incorporating Sex and Gender into Culturally Competent Simulation in Medical Education. J Womens Health (Larchmt) 2019; 28:1762-1767. [DOI: 10.1089/jwh.2018.7271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gillian A. Beauchamp
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
| | - Alyson J. McGregor
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Esther K. Choo
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
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Luethi N, Bailey M, Higgins A, Howe B, Peake S, Delaney A, Bellomo R. Gender differences in mortality and quality of life after septic shock: A post-hoc analysis of the ARISE study. J Crit Care 2019; 55:177-183. [PMID: 31739087 DOI: 10.1016/j.jcrc.2019.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/28/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE To assess the impact of gender and pre-menopausal state on short- and long-term outcomes in patients with septic shock. MATERIAL AND METHODS Cohort study of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial, an international randomized controlled trial comparing early goal-directed therapy (EGDT) to usual care in patients with early septic shock, conducted between October 2008 and April 2014. The primary exposure in this analysis was legal gender and the secondary exposure was pre-menopausal state defined by chronological age (≤ 50 years). RESULTS 641 (40.3%) of all 1591 ARISE trial participants in the intention-to-treat population were females and overall, 337 (21.2%) (146 females) patients were 50 years of age or younger. After risk-adjustment, we could not identify any survival benefit for female patients at day 90 in the younger (≤50 years) (adjusted Odds Ratio (aOR): 0.91 (0.46-1.89), p = .85) nor in the older (>50 years) age-group (aOR: 1.10 (0.81-1.49), p = .56). Similarly, there was no gender-difference in ICU, hospital, 1-year mortality nor quality of life measures. CONCLUSIONS This post-hoc analysis of a large multi-center trial in early septic shock has shown no short- or long-term survival effect for women overall as well as in the pre-menopausal age-group.
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Affiliation(s)
- Nora Luethi
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alisa Higgins
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda Howe
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sandra Peake
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Anthony Delaney
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia
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Galiatsatos P, Sun J, Welsh J, Suffredini A. Health Disparities and Sepsis: a Systematic Review and Meta-Analysis on the Influence of Race on Sepsis-Related Mortality. J Racial Ethn Health Disparities 2019; 6:900-908. [PMID: 31144133 PMCID: PMC10875732 DOI: 10.1007/s40615-019-00590-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE Racial disparities in sepsis outcomes have been previously reported. However, recently, there have been inconsistencies in identifying which socioeconomic variables, such as race, account for these disparities. The objective of this study was to perform a systematic review in order to examine the impact of race on sepsis-attributable mortality. METHODS Systematic searches for English-language articles identified through MEDLINE, EBSCOhost, PubMed, ERIC, and Cochrane Library databases from 1960 to 1 February 2017. Included studies examined sepsis outcomes in the context of sepsis incidence and/or mortality. Two investigators independently extracted data and assessed study quality. The meta-analysis was performed in accordance with the Cochrane Collaboration guidelines. RESULTS Twenty-one studies adhered to the predefined selection criteria and were included in the review. Of the 21 studies, we pooled data from 6 studies comparing African American/Black race as a risk factor for sepsis-related mortality disparities (reference group being Caucasian/White). From the meta-analysis on these six studies, African American/Black race was found to have no statistical significant relationship with sepsis-related mortality (odds ratio 1.20, 95% CI, 0.81 to 1.77). Similar results were found for other races (Native Americans, Asians) and ethnicities (Hispanic/Latinos). CONCLUSION On the basis of available evidence from a limited number of observation retrospective studies, race alone cannot fully explain sepsis-related disparities, especially sepsis-attributable mortality.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
- Medicine for the Greater Good at Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Judith Welsh
- Office of Research Services, NIH Library, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Failla KR, Connelly CD, Ecoff L, Macauley K, Bush R. Does Gender Matter in Septic Patient Outcomes? J Nurs Scholarsh 2019; 51:438-448. [PMID: 30938475 DOI: 10.1111/jnu.12478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to examine potential gender disparities in relation to factors associated with sepsis management among a cohort of patients admitted through an emergency department with a discharge diagnosis of severe sepsis or septic shock. Sepsis is one of the leading causes of death globally, with significant associated costs. Predictors of survival for those with sepsis-related diagnoses are complex. DESIGN AND METHODS The study had a retrospective, descriptive cross-sectional design. The sample (N = 482) included patients 18 years of age or older who presented to the emergency department of a nonprofit, Magnet-recognized, acute care hospital located in southern California. Subjects included those who subsequently met the criteria for a discharge diagnosis of severe sepsis or septic shock as defined by the Surviving Sepsis Campaign. Patient characteristics, clinical variables, care management processes, and outcomes were extracted from the electronic health record. A multivariate model was analyzed. FINDINGS The sample included 234 women (48.5%) and 248 men (51.5%). Logistic regression with eight independent variables (discharge diagnosis, age, comorbidities, length of hospital stay, source of infection, first serum lactate level measured, recommended fluids administered, and gender) reliably predicted odds for patient survival, ϰ2 (12) = 118.38, p < .001, and correctly classified 77.3% of cases. All eight independent variables significantly contributed to the model. Men had a higher likelihood of hospital survival than women (odds ratio 1.68; 95% confidence interval 1.01-2.79; p = .045). CONCLUSIONS The Surviving Sepsis Campaign has provided a clear pathway for care of patients with sepsis-related diagnoses. Therapeutic strategies should be developed to address differences in outcome by gender. The adoption of more aggressive applications of evidence-based interventions for these patients may result in better patient outcomes. CLINICAL RELEVANCE Providers should understand the importance of adhering to sepsis protocols, minimizing treatment disparities, and recognizing gender differences.
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Affiliation(s)
- Kim Reina Failla
- Gamma Gamma and Zeta Mu, Manager, Nurse Residency Program, Sharp Memorial Hospital, San Diego, CA, USA
| | - Cynthia D Connelly
- Zeta Mu, Professor and Director of Nursing Research, Beyster Institute of Nursing Research, University of San Diego, San Diego, CA, USA
| | - Laurie Ecoff
- Zeta Mu, Vice President, Center of Nursing Excellence, Sharp Healthcare, San Diego, CA, USA
| | - Karen Macauley
- Zeta Mu, Associate Dean of Advanced Practice Programs, Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA, USA
| | - Ruth Bush
- Professor, Beyster Institute Nursing Research, University of San Diego, San Diego, CA, USA
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Septic Shock Nonsurvivors Have Persistently Elevated Acylcarnitines Following Carnitine Supplementation. Shock 2019; 49:412-419. [PMID: 29384504 DOI: 10.1097/shk.0000000000000997] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sepsis-induced metabolic disturbances include hyperlactatemia, disruption of glycolysis, protein catabolism, and altered fatty acid metabolism. It may also lower serum L-carnitine that supports the use of L-carnitine supplementation as a treatment to ameliorate several of these metabolic consequences. METHODS To further understand the association between L-carnitine-induced changes in serum acylcarnitines, fatty acid metabolism and survival, serum samples from (T0), 12 hfollowing completion (T24) of L-carnitine (n = 16) or placebo (n = 15) administration, and 48 h (T48) after enrollment from patients with septic shock enrolled in a randomized control trial were assayed for acylcarnitines, free fatty acids, and insulin. Data were analyzed comparing 1-year survivors and nonsurvivors within treatment groups. RESULTS Mortality was 8 of 16 (50%) and 12 of 15 (80%) at 1 year for L-carnitine and placebo-treated patients, respectively. Free carnitine, C2, C3, and C8 acylcarnitines were higher among nonsurvivors at enrollment. L-Carnitine treatment increased levels of all measured acylcarnitines; an effect that was sustained for at least 36 h following completion of the infusion and was more prominent among nonsurvivors. Several fatty acids followed a similar, though less consistent pattern. Glucose, lactate, and insulin levels did not differ based on survival or treatment arm. CONCLUSIONS In human patients with septic shock, L-Carnitine supplementation increases a broad range of acylcarnitine concentrations that persist after cessation of infusion, demonstrating both immediate and sustained effects on the serum metabolome. Nonsurvivors demonstrate a distinct metabolic response to L-carnitine compared with survivors, which may indicate preexisting or more profound metabolic derangement that constrains any beneficial response to treatment.
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López-Alcalde J, Stallings E, Cabir Nunes S, Fernández Chávez A, Daheron M, Bonfill Cosp X, Zamora J. Consideration of sex and gender in Cochrane reviews of interventions for preventing healthcare-associated infections: a methodology study. BMC Health Serv Res 2019; 19:169. [PMID: 30876452 PMCID: PMC6419810 DOI: 10.1186/s12913-019-4001-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/07/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are common and increase morbidity, mortality, and healthcare costs. Their control continues to be an unresolved issue worldwide. HAIs epidemiology shows sex/gender differences. Thus the lack of consideration of sex/gender in Cochrane reviews will limit their applicability and capacity to support informed decisions. This study aims to describe the extent to which Cochrane reviews of interventions for preventing HAIs consider sex and gender. METHODS Methodology study appraising Cochrane reviews of interventions to prevent HAIs. SEARCH METHODS Cochrane Database of Systematic Reviews from 1995 (launch of the journal) to 31 December 2016. Two authors independently extracted data with EPPI-Reviewer 4 software, and independently appraised the sex/gender content of the reviews with the Sex and Gender Appraisal Tool for Systematic Reviews (SGAT-SR). RESULTS This study included 113 reviews assessing the effects of interventions for preventing HAIs. 100 reviews (88%) used at least one sex or gender-related term. The terminology used was heterogeneous, being "sex" the term used in more reviews (51%). No review defined neither sex nor gender. Thus we could not assess the definitions provided. Consideration of sex and gender was practically absent in the included reviews; in fact, no review met all the applicable items of the SGAT-SR, and 51 reviews (50%) fulfilled no item. No review provided a complete description of the sex and the gender of the samples of the included studies. Only ten reviews (10%) planned to perform sex- and gender-based analysis and only three (3%) could complete the analysis. The method chosen was always the subgroup analysis based on sex (one review) or gender (two reviews). Three reviews (3%) considered sex or gender-related findings in the conclusions. CONCLUSION Consideration of sex and gender in Cochrane reviews of interventions for preventing HAIs was practically absent. This lack of attention to sex and gender reduces the quality of Cochrane reviews, and their applicability for all people: women and men, boys and girls, and people of diverse gender identities. Cochrane should attempt to address the shortfalls detected.
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Affiliation(s)
- Jesús López-Alcalde
- Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV)-Madrid, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | | | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre, IIB Sant Pau, Universitat Autònoma de Barcelona, Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Factors Underlying Racial Disparities in Sepsis Management. Healthcare (Basel) 2018; 6:healthcare6040133. [PMID: 30463180 PMCID: PMC6315577 DOI: 10.3390/healthcare6040133] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 12/13/2022] Open
Abstract
Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.
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Forsblom E, Kakriainen A, Ruotsalainen E, Järvinen A. Comparison of patient characteristics, clinical management, infectious specialist consultation, and outcome in men and women with methicillin-sensitive Staphylococcus aureus bacteremia: a propensity-score adjusted retrospective study. Infection 2018; 46:837-845. [PMID: 30194636 DOI: 10.1007/s15010-018-1216-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sex-related treatment inequalities are suggested to explain outcome differences between men and women in Staphylococcus aureus bacteremia (SAB). We compared patient characteristics, clinical management, infectious specialist consultation (ISC) and outcome in men and women with SAB. METHODS Multicenter retrospective study of methicillin-sensitive (MS-) SAB patients categorized according to sex and ISC consultation provided within 7 days of diagnosis. RESULTS Altogether 617 SAB patients were included in the analysis: 62% males and 38% females. Male sex was associated less often to nosocomial bacteremia (OR 0.69, 95% CI 0.50-0.96, p = 0.029) and more often to alcoholism (OR 2.25, 95% CI 1.31-3.87, p = 0.003). No sex-related differences were seen in basic or immunologic laboratory tests, illness severity, intensive care unit treatment or thromboembolic events. ISC was provided to most patients (94%) irrespective of sex. No differences were seen in clinical management of men or women: Transthoracic or -esophageal echocardiography (61% vs. 65%), deep infection (77% vs. 72%), infection removal (30% vs. 27%) and anti-staphylococcal antibiotics as first-line treatment (54% vs. 51%). However, male sex was connected to more frequent adjunctive rifampicin treatment (52% vs. 41%, p = 0.025). No difference in 28- or 90-day mortality (13% vs. 13% and 18% vs. 20%) or SAB relapse (0% vs. 1%) was observed between men and women. Propensity-score adjusted Cox proportional analysis gave no connection of sex to mortality within 90 days. CONCLUSION Patient characteristics, clinical management, ISC guidance, bacteremia relapse, and outcome did not differ in men and women with MS-SAB.
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Affiliation(s)
- E Forsblom
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland.
| | - A Kakriainen
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland
| | - E Ruotsalainen
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland
| | - A Järvinen
- Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora Hospital, University of Helsinki, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029 HUS, Helsinki, Finland
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Association of Gender With Outcome and Host Response in Critically Ill Sepsis Patients. Crit Care Med 2017; 45:1854-1862. [PMID: 28806220 DOI: 10.1097/ccm.0000000000002649] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the association of gender with the presentation, outcome, and host response in critically ill patients with sepsis. DESIGN AND SETTING A prospective observational cohort study in the ICU of two tertiary hospitals between January 2011 and January 2014. PATIENTS All consecutive critically ill patients admitted with sepsis, involving 1,815 admissions (1,533 patients). INTERVENTIONS The host response was evaluated on ICU admission by measuring 19 plasma biomarkers reflecting organ systems implicated in sepsis pathogenesis (1,205 admissions) and by applying genome-wide blood gene expression profiling (582 admissions). MEASUREMENTS AND MAIN RESULTS Sepsis patients admitted to the ICU were more frequently males (61.0%; p < 0.0001 vs females). Baseline characteristics were not different between genders. Urosepsis was more common in females; endocarditis and mediastinitis in men. Disease severity was similar throughout ICU stay. Mortality was similar up to 1 year after ICU admission, and gender was not associated with 90-day mortality in multivariate analyses in a variety of subgroups. Although plasma proteome analyses (including systemic inflammatory and cytokine responses, and activation of coagulation) were largely similar between genders, females showed enhanced endothelial cell activation; this difference was virtually absent in patients more than 55 years old. More than 80% of the leukocyte blood gene expression response was similar in male and female patients. CONCLUSIONS The host response and outcome in male and female sepsis patients requiring ICU admission are largely similar.
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Tacconelli E, Foschi F. Does gender affect the outcome of community-acquired Staphylococcus aureus bacteraemia? Clin Microbiol Infect 2016; 23:23-25. [PMID: 27665701 DOI: 10.1016/j.cmi.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- E Tacconelli
- Infectious Diseases, Internal Medicine I, DZIF Centre, University Hospital of Tübingen, Tübingen, Germany.
| | - F Foschi
- Infectious Diseases, Internal Medicine I, DZIF Centre, University Hospital of Tübingen, Tübingen, Germany
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Fabbian F, De Giorgi A, López-Soto PJ, Pala M, Tiseo R, Cultrera R, Gallerani M, Manfredini R. Is female gender as harmful as bacteria? analysis of hospital admissions for urinary tract infections in elderly patients. J Womens Health (Larchmt) 2015; 24:587-92. [PMID: 25950579 DOI: 10.1089/jwh.2014.5140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and in-hospital mortality (IHM) in a cohort of hospitalized elderly subjects. METHODS All patients admitted between 2000 and 2013 to the general hospital of Ferrara, in northeast Italy, with ICD-9-CM code of UTIs were included. IHM was the main outcome, and age, sex, type of microorganism, sepsis, and Charlson comorbidity index (CCI) based on ICD-9-CM, were also analyzed. RESULTS The total sample included 2,266 patients (1,670 women, 73.7%) with UTIs and identification of a cultural organism. Mean age was 81.7±7.5 years (range, 65-103). One hundred and sixteen (5.1%, of whom 34.5% were male and 65.5% were female) cases developed sepsis, and 84 (3.7%, of whom 45.2% were male, 54.8% were female) had a fatal outcome. Nonsurvivors had lower prevalence of IVUs due to Escherichia coli (53.6 vs. 71.7%, p<0.001) and higher prevalence of UTIs due to Pseudomonas aeruginosa (19 vs 7.1%, p<0.001). Moreover, non-survivors developed more frequently sepsis (31% vs. 4.1%, p<0.001), and had higher CCI (2.81±2.43 vs. 2.21±2.04, p=0.011). IHM was independently associated, in decreasing order of odds ratios (ORs), with sepsis (OR 10.3; 95% confidence interval [95% CI] 6.113-17.460, p<0.001), P. aeruginosa infection (OR 2.541; 95% CI 1.422-4.543, p=0.002), female gender (OR 2.324; 95% CI 1.480-3.650, p<0.001), CCI (OR 1.103; 95% CI 1.005-1.210, p=0.038), age (OR 1.034; 95% CI 1.002-1.066, p=0.036), and E. coli infection (OR 0.5; 95% CI 0.320-0.780, p=0.002). CONCLUSIONS In a large sample of elderly patients hospitalized for UTIs in a single center in northeastern Italy, apart the development of sepsis, IHM was much more dependent on pathogen and female gender than comorbidity index and age.
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Affiliation(s)
- Fabio Fabbian
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Alfredo De Giorgi
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Pablo Jesús López-Soto
- 2 Department of Nursing, Maimonides Institute for Biomedical Research in Córdoba, University of Córdoba , Córdoba, Spain
| | - Marco Pala
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Ruana Tiseo
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Rosario Cultrera
- 3 Infectious Diseases Unit, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Massimo Gallerani
- 4 First Internal Medicine, Department of Medicine, Azienda Ospedaliera-Universitaria , Ferrara, Italy
| | - Roberto Manfredini
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
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Madsen TE, Napoli AM. The DISPARITY-II study: delays to antibiotic administration in women with severe sepsis or septic shock. Acad Emerg Med 2014; 21:1499-502. [PMID: 25424151 DOI: 10.1111/acem.12546] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/18/2014] [Accepted: 04/29/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early antibiotics reduce mortality in patients with severe sepsis and septic shock. Recent work demonstrated that women experience greater delays to antibiotic administration, but it is unknown if this relationship remains after adjusting for factors such as source of infection. OBJECTIVES The objective was to investigate whether gender and/or source of infection are associated with delays to antibiotics in patients with severe sepsis or septic shock. METHODS This was a retrospective, observational study in an urban academic emergency department and national Surviving Sepsis Campaign (SSC) database study site. Consecutive patients age 18 years and older admitted to intensive care with severe sepsis or septic shock and entered into the SSC database from October 2005 to March 2012 were included. Two trained research assistants, blinded to the primary outcome, used a standardized abstraction form to obtain patient demographic and clinical data, including the Sequential Organ Failure Assessment (SOFA) scores and comorbidities. Time to first antibiotic and presumed source of infection were extracted from the SSC database. Univariate analyses were performed with Pearson chi-square tests and t-tests. Linear regression was performed with time to first antibiotic as the primary outcome. Covariates, chosen a priori by study authors, included age, race, ethnicity, source of infection, SOFA score, and lactate. RESULTS A total of 771 patients were included. Women were 45.3% of the sample, the mean age was 66 years (95% confidence interval [CI] = 65.1 to 67.5 years), 19.4% were nonwhite, and 8% were Hispanic. Mean time to first antibiotic was 153 minutes (95% CI = 143 to 163 minutes) for men and 184 minutes (95% CI = 171 to 197 minutes) for women (p < 0.001). The urinary tract was source of infection for 35.2% of women (95% CI = 30.2% to 40.3%) versus 23.7% (95% CI = 19.6% to 27.8%) of men. Pneumonia was present in 46.9% of men (95% CI = 42.1% to 51.7%) versus 35.8% (95% CI = 30.8% to 40.8%) of women. The mean time to antibiotics in women was longer than in men (adjusted odds ratio [aOR] = 1.18, 95% CI = 1.07 to 1.30), even after adjusting for age, race, ethnicity, presumed source of infection, SOFA score, and lactate (p = 0.001). Those with pneumonia compared to other infections received antibiotics faster (aOR = 0.73, 95% CI = 0.66 to 0.81). There was no significant association between other sources of infection and time to antibiotics in either univariate or multivariate analysis. CONCLUSIONS Women experience longer delays to initial antibiotics among patients with severe sepsis or septic shock, even after adjusting for infectious source. Pneumonia was associated with shorter times to antibiotic administration. Future research is necessary to investigate contributors to delayed antibiotic administration in women.
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Affiliation(s)
- Tracy E. Madsen
- Division of Women's Health in Emergency Care; Alpert Medical School of Brown University/Rhode Island Hospital; Providence RI
- Department of Emergency Medicine; Alpert Medical School of Brown University/Rhode Island Hospital; Providence RI
| | - Anthony M. Napoli
- Department of Emergency Medicine; Alpert Medical School of Brown University/Rhode Island Hospital; Providence RI
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