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Zimmermann T, Kaufmann P, Amacher SA, Sutter R, Loosen G, Merdji H, Helms J, Todorov A, Gebert P, Regitz-Zagrosek V, Gebhard C, Singer M, Siegemund M, Gebhard CE. Sex differences in the SOFA score of ICU patients with sepsis or septic shock: a nationwide analysis. Crit Care 2024; 28:209. [PMID: 38937819 PMCID: PMC11210104 DOI: 10.1186/s13054-024-04996-y] [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: 03/11/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The Sequential Organ Failure Assessment (SOFA) score is an important tool in diagnosing sepsis and quantifying organ dysfunction. However, despite emerging evidence of differences in sepsis pathophysiology between women and men, sex is currently not being considered in the SOFA score. We aimed to investigate potential sex-specific differences in organ dysfunction, as measured by the SOFA score, in patients with sepsis or septic shock and explore outcome associations. METHODS Retrospective analysis of sex-specific differences in the SOFA score of prospectively enrolled ICU patients with sepsis or septic shock admitted to one of 85 certified Swiss ICUs between 01/2021 and 12/2022. RESULTS Of 125,782 patients, 5947 (5%) were admitted with a clinical diagnosis of sepsis (2244, 38%) or septic shock (3703, 62%). Of these, 5078 (37% women) were eligible for analysis. A statistically significant difference of the total SOFA score on admission was found between women (mean 7.5 ± SD 3.6 points) and men (7.8 ± 3.6 points, Wilcoxon rank-sum p < 0.001). This was driven by differences in the coagulation (p = 0.008), liver (p < 0.001) and renal (p < 0.001) SOFA components. Differences between sexes were more prominent in younger patients < 52 years of age (women 7.1 ± 4.0 points vs men 8.1 ± 4.2 points, p = 0.004). No sex-specific differences were found in ICU length of stay (women median 2.6 days (IQR 1.3-5.3) vs men 2.7 days (IQR 1.2-6.0), p = 0.13) and ICU mortality (women 14% vs men 15%, p = 0.17). CONCLUSION Sex-specific differences exist in the SOFA score of patients admitted to a Swiss ICU with sepsis or septic shock, particularly in laboratory-based components. Although the clinical meaningfulness of these differences is unclear, a reevaluation of sex-specific thresholds for SOFA score components is warranted in an attempt to make more accurate and individualised classifications.
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Affiliation(s)
- Tobias Zimmermann
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK.
- University of Basel, Basel, Switzerland.
| | - Philip Kaufmann
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Simon A Amacher
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gregor Loosen
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Hamid Merdji
- Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Faculté de Médecine, Nouvel Hôpital Civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Julie Helms
- Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Faculté de Médecine, Nouvel Hôpital Civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Atanas Todorov
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vera Regitz-Zagrosek
- University of Zurich, Zurich, Switzerland
- Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Catherine Gebhard
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Department of Cardiology, Inselspital Bern, Bern, Switzerland
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Caroline E Gebhard
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Chang Z, Lu J, Zhang Q, Wu H, Liang Z, Pan X, Li B, Cheng ZJ, Sun B. Clinical biomarker profiles reveals gender differences and mortality factors in sepsis. Front Immunol 2024; 15:1413729. [PMID: 38835774 PMCID: PMC11148215 DOI: 10.3389/fimmu.2024.1413729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
Background Sepsis is a major contributor to global morbidity and mortality, affecting millions each year. Notwithstanding the decline in sepsis incidence and mortality over decades, gender disparities in sepsis outcomes persist, with research suggesting higher mortality rates in males. Methods This retrospective study aims to delineate gender-specific clinical biomarker profiles impacting sepsis progression and mortality by examining sepsis cases and related clinical data from the past three years. Propensity score matching was used to select age-matched healthy controls for comparison. Results Among 265 sepsis patients, a significantly higher proportion were male (60.8%, P<0.001). While mortality did not significantly differ by gender, deceased patients were significantly older (mean 69 vs 43 years, P=0.003), more likely to have hypertension (54% vs 25%, P=0.019), and had higher SOFA scores (mean ~10 vs 4, P<0.01) compared to survivors. Principal Component Analysis (PCA) showed clear separation between sepsis patients and healthy controls. 48 serum biomarkers were significantly altered in sepsis, with Triiodothyronine, Apolipoprotein A, and Serum cystatin C having the highest diagnostic value by ROC analysis. Gender-stratified comparisons identified male-specific (e.g. AFP, HDLC) and female-specific (e.g. Rheumatoid factor, Interleukin-6) diagnostic biomarkers. Deceased patients significantly differed from survivors, with 22 differentially expressed markers; Antithrombin, Prealbumin, HDL cholesterol, Urea nitrogen and Hydroxybutyrate had the highest diagnostic efficiency for mortality. Conclusion These findings enhance our understanding of gender disparities in sepsis and may guide future therapeutic strategies. Further research is warranted to validate these biomarker profiles and investigate the molecular mechanisms underlying these gender differences in sepsis outcomes.
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Affiliation(s)
- Zhenglin Chang
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, Guangdong, China
| | - Jiancai Lu
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qitai Zhang
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haojie Wu
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiman Liang
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaocong Pan
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bishan Li
- State Key Laboratory of Respiratory Disease, Department of Blood Transfusion, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhangkai J Cheng
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, Guangdong, China
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, Guangdong, China
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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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Wang CP, Hsieh MS, Hu SY, Huang SC, Tsai CA, Shen CH. Risk Factors and Scoring Systems to Predict the Mortality Risk of Afebrile Adult Patients with Monomicrobial Gram-Negative Bacteremia: A 10-Year Observational Study in the Emergency Department. Diagnostics (Basel) 2024; 14:869. [PMID: 38732284 PMCID: PMC11083546 DOI: 10.3390/diagnostics14090869] [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: 03/19/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The mortality rate of afebrile bacteremia has been reported to be as high as 45%. This investigation focused on the risk factors and predictive performance of scoring systems for the clinical outcomes of afebrile patients with monomicrobial gram-negative bacteria (GNB) in the emergency department (ED). METHODS We conducted a retrospective analysis of afebrile adult ED patients with monomicrobial GNB bacteremia from January 2012 to December 2021. We dissected the demographics, clinical pictures, and laboratory investigations. We applied five scoring systems and three revised systems to predict the clinical outcomes. RESULTS There were 600 patients included (358 males and 242 females), with a mean age of 69.6 ± 15.4 years. The overall mortality rate was 50.17%, reaching 68.52% (74/108) in cirrhotic patients. Escherichia coli was the leading pathogen (42.83%). The non-survivors had higher scores of the original MEDS (p < 0.001), NEWS (p < 0.001), MEWS (p < 0.001), qSOFA (p < 0.001), and REMS (p = 0.030). In univariate logistic regression analyses, several risk factors had a higher odds ratio (OR) for mortality, including liver cirrhosis (OR 2.541, p < 0.001), malignancy (OR 2.259, p < 0.001), septic shock (OR 2.077, p = 0.002), and male gender (OR 0.535, p < 0.001). The MEDS demonstrated that the best predictive power with the maximum area under the curve (AUC) was measured at 0.773 at the cut-off point of 11. The AUCs of the original NEWS, MEWS, qSOFA, and REMS were 0.663, 0.584, 0.572, and 0.553, respectively. We revised the original MEDS, NEWS, and qSOFA by adding red cell distribution width, albumin, and lactate scores and found a better predictive power of the AUC of 0.797, 0.719, and 0.694 on the revised MEDS ≥11, revised qSOFA ≥ 3, and revised NEWS ≥ 6, respectively. CONCLUSIONS The original MEDS, revised MEDS, revised qSOFA, and revised NEWS were valuable tools for predicting the mortality risk in afebrile patients with monomicrobial GNB bacteremia. We suggested that clinicians should explore patients with the risk factors mentioned above for possible severe infection, even in the absence of fever and initiate hemodynamic support and early adequate antibiotic therapy in patients with higher scores of the original MEDS (≥11), revised MEDS (≥11), revised NEWS (≥6), and revised qSOFA (≥3).
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Affiliation(s)
- Chung-Pang Wang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-P.W.); (C.-H.S.)
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan;
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-P.W.); (C.-H.S.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Shih-Che Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Lung Cancer Research Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Che-An Tsai
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chia-Hui Shen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-P.W.); (C.-H.S.)
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Sharma N, Chen A, Heinen L, Liu R, Dwivedi DJ, Zhou J, Lalu MM, Mendelson AA, McDonald B, Kretz CA, Fox-Robichaud AE, Liaw PC. Impact of age on the host response to sepsis in a murine model of fecal-induced peritonitis. Intensive Care Med Exp 2024; 12:28. [PMID: 38457063 PMCID: PMC10923763 DOI: 10.1186/s40635-024-00609-8] [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: 12/15/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Despite older adults being more vulnerable to sepsis, most preclinical research on sepsis has been conducted using young animals. This results in decreased scientific validity since age is an independent predictor of poor outcome. In this study, we explored the impact of aging on the host response to sepsis using the fecal-induced peritonitis (FIP) model developed by the National Preclinical Sepsis Platform (NPSP). METHODS C57BL/6 mice (3 or 12 months old) were injected intraperitoneally with rat fecal slurry (0.75 mg/g) or a control vehicle. To investigate the early stage of sepsis, mice were culled at 4 h, 8 h, or 12 h to investigate disease severity, immunothrombosis biomarkers, and organ injury. Mice received buprenorphine at 4 h post-FIP. A separate cohort of FIP mice were studied for 72 h (with buprenorphine given at 4 h, 12 h, and then every 12 h post-FIP and antibiotics/fluids starting at 12 h post-FIP). Organs were harvested, plasma levels of Interleukin (IL)-6, IL-10, monocyte chemoattract protein (MCP-1)/CCL2, thrombin-antithrombin (TAT) complexes, cell-free DNA (CFDNA), and ADAMTS13 activity were quantified, and bacterial loads were measured. RESULTS In the 12 h time course study, aged FIP mice demonstrated increased inflammation and injury to the lungs compared to young FIP mice. In the 72 h study, aged FIP mice exhibited a higher mortality rate (89%) compared to young FIP mice (42%) (p < 0.001). Aged FIP non-survivors also exhibited a trend towards elevated IL-6, TAT, CFDNA, CCL2, and decreased IL-10, and impaired bacterial clearance compared to young FIP non-survivors. CONCLUSION To our knowledge, this is the first study to investigate the impact of age on survival using the FIP model of sepsis. Our model includes clinically-relevant supportive therapies and inclusion of both sexes. The higher mortality rate in aged mice may reflect increased inflammation and worsened organ injury in the early stage of sepsis. We also observed trends in impaired bacterial clearance, increase in IL-6, TAT, CFDNA, CCL2, and decreased IL-10 and ADAMTS13 activity in aged septic non-survivors compared to young septic non-survivors. Our aging model may help to increase the scientific validity of preclinical research and may be useful for identifying mechanisms of age-related susceptibility to sepsis as well as age-specific treatment strategies.
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Affiliation(s)
- Neha Sharma
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Alex Chen
- McMaster University, Hamilton, ON, Canada
| | | | - Ruth Liu
- McMaster University, Hamilton, ON, Canada
| | - Dhruva J Dwivedi
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ji Zhou
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Manoj M Lalu
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Department of Cellular and Molecular Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Asher A Mendelson
- Section of Critical Care Medicine, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Braedon McDonald
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Colin A Kretz
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alison E Fox-Robichaud
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patricia C Liaw
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
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Piriyapatsom A, Trisukhonth A, Chintabanyat O, Chaiwat O, Kongsayreepong S, Thanakiattiwibun C. Adherence to lung protective mechanical ventilation in patients admitted to a surgical intensive care unit and the associated increased mortality. Heliyon 2024; 10:e26220. [PMID: 38404779 PMCID: PMC10884462 DOI: 10.1016/j.heliyon.2024.e26220] [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: 08/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Background The adherence rate to the lung protective ventilation (LPV) strategy, which is generally accepted as a standard practice in mechanically ventilated patients, reported in the literature is approximately 40%. This study aimed to determine the adherence rate to the LPV strategy, factors associated with this adherence, and related clinical outcomes in mechanically ventilated patients admitted to the surgical intensive care unit (SICU). Methods This prospective observational study was conducted in the SICU of a tertiary university-based hospital between April 2018 and February 2019. Three hundred and six adult patients admitted to the SICU who required mechanical ventilation support for more than 12 h were included. Ventilator parameters at the initiation of mechanical ventilation support in the SICU were recorded. The LPV strategy was defined as ventilation with a tidal volume of equal or less than 8 ml/kg of predicted body weight plus positive end-expiratory pressure of at least 5 cm H2O. Demographic and clinical data were recorded and analyzed. Results There were 306 patients included in this study. The adherence rate to the LPV strategy was 36.9%. Height was the only factor associated with adherence to the LPV strategy (odds ratio for each cm, 1.10; 95% confidence interval (CI), 1.06-1.15). Cox regression analysis showed that the LPV strategy was associated with increased 90-day mortality (hazard ratio, 1.73; 95% CI, 1.02-2.94). Conclusion The adherence rate to the LPV strategy among patients admitted to the SICU was modest. Further studies are warranted to explore whether the application of the LPV strategy is simply a marker of disease severity or a causative factor for increased mortality.
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Affiliation(s)
- Annop Piriyapatsom
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Ajana Trisukhonth
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Ornin Chintabanyat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Suneerat Kongsayreepong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Chayanan Thanakiattiwibun
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
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Yan D, Xie X, Fu X, Xu D, Li N, Yao R. Construction and evaluation of short -term and long -term mortality risk prediction model for patients with sepsis based on MIMIC -IV database. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2024; 49:256-265. [PMID: 38755721 PMCID: PMC11103058 DOI: 10.11817/j.issn.1672-7347.2024.230390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Given the high incidence and mortality rate of sepsis, early identification of high-risk patients and timely intervention are crucial. However, existing mortality risk prediction models still have shortcomings in terms of operation, applicability, and evaluation on long-term prognosis. This study aims to investigate the risk factors for death in patients with sepsis, and to construct the prediction model of short-term and long-term mortality risk. METHODS Patients meeting sepsis 3.0 diagnostic criteria were selected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and randomly divided into a modeling group and a validation group at a ratio of 7꞉3. Baseline data of patients were analyzed. Univariate Cox regression analysis and full subset regression were used to determine the risk factors of death in patients with sepsis and to screen out the variables to construct the prediction model. The time-dependent area under the curve (AUC), calibration curve, and decision curve were used to evaluate the differentiation, calibration, and clinical practicability of the model. RESULTS A total of 14 240 patients with sepsis were included in our study. The 28-day and 1-year mortality were 21.45% (3 054 cases) and 36.50% (5 198 cases), respectively. Advanced age, female, high sepsis-related organ failure assessment (SOFA) score, high simplified acute physiology score II (SAPS II), rapid heart rate, rapid respiratory rate, septic shock, congestive heart failure, chronic obstructive pulmonary disease, liver disease, kidney disease, diabetes, malignant tumor, high white blood cell count (WBC), long prothrombin time (PT), and high serum creatinine (SCr) levels were all risk factors for sepsis death (all P<0.05). Eight variables, including PT, respiratory rate, body temperature, malignant tumor, liver disease, septic shock, SAPS II, and age were used to construct the model. The AUCs for 28-day and 1-year survival were 0.717 (95% CI 0.710 to 0.724) and 0.716 (95% CI 0.707 to 0.725), respectively. The calibration curve and decision curve showed that the model had good calibration degree and clinical application value. CONCLUSIONS The short-term and long-term mortality risk prediction models of patients with sepsis based on the MIMIC-IV database have good recognition ability and certain clinical reference significance for prognostic risk assessment and intervention treatment of patients.
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Affiliation(s)
- Danyang Yan
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410008.
| | - Xi Xie
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410008
| | - Xiangjie Fu
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410008
| | - Daomiao Xu
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ning Li
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410008
| | - Run Yao
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha 410008.
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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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9
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Ibrahim DR, Saadi AT, Yahya NB, Ibrahim MS, Saeed AY, Abdulaziz SS, Hasqyal RY, Alarsalani BK, Ibrahim KS. Retrospective analysis of pediatric sepsis and the burden of antimicrobial resistance in Duhok, Kurdistan Region of Iraq. Front Pharmacol 2024; 15:1347832. [PMID: 38469402 PMCID: PMC10925647 DOI: 10.3389/fphar.2024.1347832] [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] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction: Sepsis is a life-threatening complication in pediatric patients. This study primarily aimed to investigate sepsis-causing bacteria and their antimicrobial resistance profile and check the change in the antimicrobial resistance trend for some selected bacteria. In addition, we evaluated the incidence of sepsis, the related mortality rate, and the effectiveness and outcome of the treatment regimes in sepsis pediatric patients. Methods: A retrospective analysis was conducted on 4-year data (2018-2021) collected from three intensive care units at the Hevi Pediatric Teaching Hospital. Sepsis screening involved clinical detection and confirmation by blood culture. Results: A total of 520 out of 1,098 (47.35%) blood samples showed positive microbial growth. A decrease in sepsis rate was observed during the COVID-19 pandemic. Coagulase-negative Staphylococci (CoNS) and Klebsiella pneumonia were the most commonly isolated bacteria. A notable variation in the antimicrobial resistance trend was observed among sepsis-causing bacteria. The empirical sepsis treatment recommended by the WHO was ineffective, as certain bacteria exhibited 100% resistance to every antibiotic tested. The mortality rate significantly increased from 1.3% in 2018 to 16.5% in 2021. Discussion: The antimicrobial resistance profile of sepsis causing bacteria is of concerns, indicating a potentially serious situation. Thus, to avoid treatment failure, the monitoring of antimicrobial resistance in pediatric patients is essential.
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Affiliation(s)
- Delveen R. Ibrahim
- Department of Biology, Collage of Science, University of Duhok, Duhok, Kurdistan Region, Iraq
| | - Abdulrhaman T. Saadi
- Medical Microbiology Department, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
- Heevi Pediatrics Teaching Hospital, Duhok Health Directorate, Duhok, Kurdistan Region, Iraq
| | - Nizar B. Yahya
- Heevi Pediatrics Teaching Hospital, Duhok Health Directorate, Duhok, Kurdistan Region, Iraq
- Pediatrics Department, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
| | - Marwa S. Ibrahim
- Department of Medical Laboratory Technology, College of Health and Medical Techniques-Shekhan, Duhok Polytechnic University, Duhok, Kurdistan Region, Iraq
| | - Ali Y. Saeed
- Department of Biology, Collage of Science, University of Duhok, Duhok, Kurdistan Region, Iraq
| | - Sawsan S. Abdulaziz
- Heevi Pediatrics Teaching Hospital, Duhok Health Directorate, Duhok, Kurdistan Region, Iraq
| | - Revan Y. Hasqyal
- Heevi Pediatrics Teaching Hospital, Duhok Health Directorate, Duhok, Kurdistan Region, Iraq
| | - Berivan K. Alarsalani
- Heevi Pediatrics Teaching Hospital, Duhok Health Directorate, Duhok, Kurdistan Region, Iraq
| | - Khalid S. Ibrahim
- Department of Biology, College of Sciences, University of Zakho, Zakho, Kurdistan Region, Iraq
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10
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Khana TQ, Anwar KA. Detection of Inflammatory Biomarkers Among Patients with Sepsis of Gram-Negative Bacteria: A Cross-Sectional Study. Int J Gen Med 2023; 16:3963-3976. [PMID: 37670930 PMCID: PMC10476660 DOI: 10.2147/ijgm.s415200] [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: 05/08/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023] Open
Abstract
Background Sepsis is a highly mixed ailment that affects patients with numerous conditions of infectious sources and can lead to multi-organ failure with dysregulated host immune response. Objective To determine inflammatory biomarkers in patients with sepsis caused by Gram-negative bacteria and compare their role in the early detection of sepsis. Methods This cross-sectional study was conducted on patients with sepsis admitted to the intensive care unit at different hospitals in Sulaimaniyah, Iraq, from May to December 2021. Patients (n=147) were enrolled in this study according to the primary diagnosis of sepsis by Sequential Organ Failure Assessment scores. Blood samples were taken from patients to investigate white blood cells, inflammatory biomarkers (pentraxin-3, procalcitonin, adrenomedullin, lipopolysaccharide binding protein, interleukin-17A, lactate dehydrogenase, and C-creative protein), blood culture, antibiotic susceptibility test, and coagulation biomarkers (Prothrombin time, activated partial thromboplastin time, and international normalized ratio). Then, isolated Gram-negative bacteria were tested for extended-spectrum β-lactamase enzymes production by screening and combined disc tests. Results A total of 51.7% samples were blood culture positive for different Gram-negative bacteria, and P. aeruginosa (51.95%) was a more isolated bacterium. Both males and females were affected by sepsis in a ratio of 1.23:1 with different age groups. Extended-spectrum β-lactamase was estimated to be 77.2% by antibiotic profile, and the rate decreased using two double-disc synergy tests. This was confirmed by combined disc test at a rate of 41.35%. The most prevalent biomarkers were procalcitonin (88.16%), adrenomedullin (84.21%), pentraxin-3 (22.37%), and lipopolysaccharide binding protein (11.84%). Conclusion Sepsis is a life-threatening condition that can be diagnosed early by several blood biomarkers such as procalcitonin, adrenomedullin, and pentraxin-3 combined with a standard blood culture technique to improve the patient outcome.
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Affiliation(s)
- Thikra Qader Khana
- Microbiology Department, Shar Teaching Hospital, Sulaimaniyah Directorate of Health, Sulaimaniyah, Iraq
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11
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Prout AJ, Banks RK, Reeder RW, Zimmerman JJ, Meert KL. Association of Sex and Age with Mortality and Health-Related Quality of Life in Children with Septic Shock: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation. J Intensive Care Med 2023; 39:8850666231190270. [PMID: 37529851 DOI: 10.1177/08850666231190270] [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] [Indexed: 08/03/2023]
Abstract
Introduction: Sepsis is more common in males than females, but whether outcomes differ by sex in various pediatric age groups is unclear. The Life After Pediatric Sepsis Evaluation (LAPSE) was a multicenter prospective cohort study that evaluated health-related quality of life (HRQL) in children after community-acquired septic shock. In this secondary analysis, we evaluated whether male children are at increased risk of mortality or long-term decline in HRQL than female children by age group. Methods: Children (1 month-18 years) with community-acquired septic shock were recruited from 12 pediatric intensive care units in the U.S. Data included sex, age group (<1 year, 1-<13 years, 13-18 years), acute illness severity (acute organ dysfunction and inflammation), and longitudinal assessments of HRQL and mortality. Persistent decline in HRQL was defined as a 10% decrease in HRQL comparing baseline to 3 months following admission. Male and female children were stratified by age group and compared to evaluate the difference in the composite outcome of death or persistent decline in HRQL using the Cochran-Mantel-Haenszel test. Results: Of 389 children, 54.2% (n = 211) were male. Overall, 10% (21/211) of males and 12% (22/178) of females died by 3 months (p = 0.454). Among children with follow-up data, 41% (57/138) of males and 44% (48/108) of females died or had persistent decline in HRQL at 3 months (p = 0.636), with no observed difference by sex when stratified by age group. There was no significant difference in acute illness severity between males and females overall or stratified by age group. Conclusions: In this secondary analysis of the LAPSE cohort, HRQL, and mortality were not different between male and female children when stratified by age group. There were no significant differences by sex across multiple measures of illness severity or treatment intensity.
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Affiliation(s)
- Andrew J Prout
- Section of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University School of Medicine, Mt. Pleasant, MI, USA
| | - Russell K Banks
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jerry J Zimmerman
- Section of Pediatric Critical Care, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen L Meert
- Section of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University School of Medicine, Mt. Pleasant, MI, USA
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12
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Abdelbaky AM, Elmasry WG, Awad AH. Lower Versus Higher Oxygenation Targets for Critically Ill Patients: A Systematic Review. Cureus 2023; 15:e41330. [PMID: 37408938 PMCID: PMC10318567 DOI: 10.7759/cureus.41330] [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: 07/03/2023] [Indexed: 07/07/2023] Open
Abstract
Supplemental oxygen is a standard therapeutic intervention for critically ill patients such as patients suffering from cardiac arrest, myocardial ischemia, traumatic brain injury, and stroke. However, the optimal oxygenation targets remain elusive owing to the paucity and inconsistencies in the relevant literature. A comprehensive analysis of the available scientific evidence was performed to establish the relative efficacy of the lower and higher oxygenation targets. A systematic literature search was conducted in PubMed, MEDLINE, and Scopus databases from 2010 to 2023. Further, Google Scholar was also searched. Studies evaluating the efficacy of oxygenation targets and the associated clinical outcomes were included. Studies that included participants with hyperbaric oxygen therapy, chronic respiratory diseases, or extracorporeal life support were excluded. The literature search was performed by two blinded reviewers. A total of 19 studies were included in this systemic review, including 72,176 participants. A total of 14 randomized control trials were included. A total of 12 studies investigated the efficacy of lower and higher oxygenation targets in ICU-admitted patients, and seven were assessed in patients with acute myocardial infarction and stroke. For ICU patients, the evidence was conflicting, with some studies showing the efficacy of conservative oxygen therapy while others reported no difference. Overall, nine studies concluded that lower oxygen targets are favorable. However, most studies (n=4) in stroke and myocardial infarction patients showed no difference in lower or higher oxygenation targets whereas only two supported lower oxygenation targets. Available evidence suggests that lower oxygenation targets result in either improved or equivalent clinical outcomes compared with higher oxygenation targets.
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Affiliation(s)
- Ahmed M Abdelbaky
- Intensive Care Unit, Dubai Academic Health Corporation - Rashid Hospital, Dubai, ARE
| | - Wael G Elmasry
- Intensive Care Unit, Dubai Academic Health Corporation - Rashid Hospital, Dubai, ARE
| | - Ahmed H Awad
- Intensive Care Unit, Dubai Academic Health Corporation - Rashid Hospital, Dubai, ARE
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13
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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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14
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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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15
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Deutz NEP, Singer P, Wierzchowska-McNew RA, Viana MV, Ben-David IA, Pantet O, Thaden JJ, Ten Have GAM, Engelen MPKJ, Berger MM. Females have a different metabolic response to critical illness, measured by comprehensive amino acid flux analysis. Metabolism 2023; 142:155400. [PMID: 36717057 DOI: 10.1016/j.metabol.2023.155400] [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: 10/25/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND The trajectory from healthy to critical illness is influenced by numerous factors, including metabolism, which differs substantially between males and females. Whole body protein breakdown is substantially increased in critically ill patients, but it remains unclear whether there are sex differences that could explain the different health outcomes. Hence, we performed a secondary analysis of a study, where we used a novel pulse isotope method in critically ill and matched healthy males and females. METHODS In 51 critically ill ICU patients (26 males, 15 females) and 49 healthy controls (36 males and 27 females), we assessed their general and disease characteristics and collected arterial(ized) blood in the postabsorptive state after pulse administration of 8 ml of a solution containing 18 stable AA tracers. In contrast to the original study, we now fitted the decay curves and calculated non-compartmental whole body amino acid production (WBP) and compartmental measurements of metabolism, including intracellular amino acid production. We measured amino acid enrichments and concentrations by LC-MS/MS and derived statistics using AN(C)OVA. RESULTS Critically ill males and females showed an increase in the WBP of many amino acids, including those related to protein breakdown, but females showed greater elevations, or in the event of a reduction, attenuated reductions. Protein breakdown-independent WBP differences remained between males and females, notably increased glutamine and glutamate WBP. Only severely ill females showed a lower increase in WBP of many amino acids in comparison to moderately ill females, suggesting a suppressed metabolism. Compartmental analysis supported the observations. CONCLUSIONS The present study shows that females have a different response to critical illness in the production of several amino acids and changes in protein breakdown, observations made possible using our innovative stable tracer pulse approach. CLINICAL TRIAL REGISTRY Data are from the baseline measurements of study NCT02770092 (URL: https://clinicaltrials.gov/ct2/show/NCT02770092) and NCT03628365 (URL: https://clinicaltrials.gov/ct2/show/NCT03628365).
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Affiliation(s)
- Nicolaas E P Deutz
- Center for Translational Research in Aging & Longevity, Texas A&M University, United States of America.
| | - Pierre Singer
- Dept of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Marina V Viana
- Dept of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Itai A Ben-David
- Dept of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Olivier Pantet
- Dept of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - John J Thaden
- Center for Translational Research in Aging & Longevity, Texas A&M University, United States of America
| | - Gabriella A M Ten Have
- Center for Translational Research in Aging & Longevity, Texas A&M University, United States of America
| | - Mariëlle P K J Engelen
- Center for Translational Research in Aging & Longevity, Texas A&M University, United States of America
| | - Mette M Berger
- Dept of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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16
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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: 16] [Impact Index Per Article: 16.0] [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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Maegele M, Aletti F, Efron PA, Relja B, Orfanos SE. NEW INSIGHTS INTO THE PATHOPHYSIOLOGY OF TRAUMA AND HEMORRHAGE. Shock 2023; 59:6-9. [PMID: 36867756 DOI: 10.1097/shk.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ABSTRACT Circulatory shock from trauma and hemorrhage remains a clinical challenge with mortality still high within the first hours after impact. It represents a complex disease involving the impairment of a number of physiological systems and organs and the interaction of different pathological mechanisms. Multiple external and patient-specific factors may further modulate and complicate the clinical course. Recently, novel targets and models with complex multiscale interaction of data from different sources have been identified which offer new windows of opportunity. Future works needs to consider patient-specific conditions and outcomes to mount shock research onto the next higher level of precision and personalized medicine.
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Affiliation(s)
- Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, Institute for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany
| | - Federico Aletti
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, Brazil
| | - Philip A Efron
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Laboratory of Inflammation Biology and Surgical Science, UF Health Critical Care Organization, Florida
| | - Borna Relja
- Department of Radiology and Nuclear Medicine, Experimental Radiology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stylianos E Orfanos
- 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
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18
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Sodhi A, Cox-Flaherty K, Greer MK, Lat TI, Gao Y, Polineni D, Pisani MA, Bourjeily G, Glassberg MK, D'Ambrosio C. Sex and Gender in Lung Diseases and Sleep Disorders: A State-of-the-Art Review: Part 2. Chest 2023; 163:366-382. [PMID: 36183784 PMCID: PMC10083131 DOI: 10.1016/j.chest.2022.08.2240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
There is now ample evidence that differences in sex and gender contribute to the incidence, susceptibility, presentation, diagnosis, and clinical course of many lung diseases. Some conditions are more prevalent in women, such as pulmonary arterial hypertension and sarcoidosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as the higher number of exacerbations experienced by women with cystic fibrosis (CF), more fatigue in women with sarcoidosis, and more difficulty in achieving smoking cessation. Outcomes such as mortality may be different as well, as indicated by the higher mortality in women with CF. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors are often not adequately addressed in clinical trials. Various aspects of lung/sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for all patients. This article is the second part of a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of selected lung diseases. We review the more recent literature and focus on guidelines incorporating sex and gender differences in pulmonary hypertension, CF and non-CF bronchiectasis, sarcoidosis, restless legs syndrome and insomnia, and critical illness. We also provide a summary of the effects of pregnancy on lung diseases and discuss the impact of sex and gender on tobacco use and treatment of nicotine use disorder.
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Affiliation(s)
- Amik Sodhi
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Katherine Cox-Flaherty
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Meredith Kendall Greer
- Division of Pulmonary, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Tasnim I Lat
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Health, Temple, TX
| | - Yuqing Gao
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Deepika Polineni
- Division of Pulmonary, Critical Care and Sleep Medicine, Washington University at St. Louis, St. Louis, MO
| | - Margaret A Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Ghada Bourjeily
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Marilyn K Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Carolyn D'Ambrosio
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
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Shields CA, Wang X, Cornelius DC. Sex differences in cardiovascular response to sepsis. Am J Physiol Cell Physiol 2023; 324:C458-C466. [PMID: 36571442 PMCID: PMC9902216 DOI: 10.1152/ajpcell.00134.2022] [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: 03/29/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
Recently, there has been increased recognition of the importance of sex as a biological factor affecting disease and health. Many preclinical studies have suggested that males may experience a less favorable outcome in response to sepsis than females. The underlying mechanisms for these differences are still largely unknown but are thought to be related to the beneficial effects of estrogen. Furthermore, the immunosuppressive role of testosterone is also thought to contribute to the sex-dependent differences that are present in clinical sepsis. There are still significant knowledge gaps in this field. This mini-review will provide a brief overview of sex-dependent variables in relation to sepsis and the cardiovascular system. Preclinical animal models for sepsis research will also be discussed. The intent of this mini-review is to inspire interest for future considerations of sex-related variables in sepsis that should be addressed to increase our understanding of the underlying mechanisms in sepsis-induced cardiovascular dysfunction for the identification of therapeutic targets and improved sepsis management and treatment.
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Affiliation(s)
- Corbin A Shields
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Xi Wang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Denise C Cornelius
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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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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Cheng H, Wang Z, Gu WJ, Yang X, Song S, Huang T, Lyu J. Impact of Falls Within 3 Months on the Short-Term Prognoses of Elderly Patients in Intensive Care Units: A Retrospective Cohort Study Using Stabilized Inverse Probability Treatment Weighting. Clin Interv Aging 2022; 17:1779-1792. [PMID: 36506850 PMCID: PMC9733442 DOI: 10.2147/cia.s387148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background Falls are a major public health problem in the older adults that can lead to poor clinical outcomes. There have been few reports on the short-term prognoses of older critically ill patients, and so we sought to determine the impact of falls on elderly patients in intensive care units (ICUs). Patients and Methods This retrospective study of 4503 patients (aged 65 years or older) analyzed data in the Medical Information Mart for Intensive Care-III critical care database. Of those, 2459 (54.6%) older adults are males, and 2044 (45.4%) older adults are females. Based on information from the medical care record assessment forms, patients were classified into the following two groups based on whether they had a fall within the previous 3 months: falls (n=1142) and nonfalls (n=3361). The primary outcomes of this study were 30- and 90-day mortality. Associations between the results of the Kaplan-Meier (KM) survival analysis, Cox proportional-hazards regression models, and subgroup analysis and its outcomes were analyzed using stabilized inverse probability treatment weighting (IPTW). Results KM survival curves with stabilized IPTW indicated that 30- and 90-day survival rates were significantly lower in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls (all p<0.001). Multivariate Cox proportional-hazards regression analysis indicated that 30- and 90-day mortality rates were 1.35 times higher (95% confidence interval [CI]=1.16-1.57, p<0.001) and 1.36 times higher (95% CI=1.19-1.55, p<0.001), respectively, in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls. Conclusion Experience of falls within the previous 3 months prior to ICU admission increased the risk of short-term mortality and affected the prognoses of elderly patients. Falls should therefore receive adequate attention from clinical healthcare providers and management decision-makers.
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Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Wan-Jie Gu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Xin Yang
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, People’s Republic of China,Correspondence: Jun Lyu, Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China, Tel +86-20-38680061, Email
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22
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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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23
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Is donor-recipient sex associated with transfusion-related outcomes in critically ill patients? Blood Adv 2022; 6:6076-6077. [PMID: 36103149 PMCID: PMC9720514 DOI: 10.1182/bloodadvances.2022008432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022] Open
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Efron PA, Darden DB, Li EC, Munley J, Kelly L, Fenner B, Nacionales DC, Ungaro RF, Dirain ML, Rincon J, Mankowski RT, Leeuwenburgh C, Moore FA, Brakenridge SC, Foster TC, Laitano O, Casadesus G, Moldawer LL, Mohr AM, Thomas RM. Sex differences associate with late microbiome alterations after murine surgical sepsis. J Trauma Acute Care Surg 2022; 93:137-146. [PMID: 35324554 PMCID: PMC9323556 DOI: 10.1097/ta.0000000000003599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sepsis-induced gut microbiome alterations contribute to sepsis-related morbidity and mortality. Given evidence for improved postsepsis outcomes in females compared with males, we hypothesized that female mice maintain microbiota resilience versus males. METHODS Mixed-sex C57BL/6 mice underwent cecal ligation and puncture (CLP) with antibiotics, saline resuscitation, and daily chronic stress and were compared with naive (nonsepsis/no antibiotics) controls. For this work, the results of young (3-5 months) and old (18-22 months) adult mice were analyzed by sex, independent and dependent of age. Mice were sacrificed at days 7 and 14, and 16S rRNA gene sequencing was performed on fecal bacterial DNA. α and β diversity were determined by Shannon index and Bray-Curtis with principal coordinate analysis, respectively. False discovery rate (FDR) correction was implemented to account for potential housing effect. RESULTS In control mice, there was no difference in α or β diversity between male and female mice (FDR, 0.76 and 0.99, respectively). However, male mice that underwent CLP with daily chronic stress had a decrease in microbiota α diversity at 7 days post-CLP (Shannon FDR, 0.005), which was sustained at 14 days post-CLP (Shannon FDR, 0.001), compared with baseline. In addition, male mice maintained differences in β diversity even at day 14 compared with controls (FDR, <0.0001). In contrast, female mice had a decreased microbiota α diversity (Shannon FDR, 0.03) and β diversity (FDR, 0.02) 7 days post-CLP but recovered their α and β diversity by post-CLP day 14 (Shannon FDR, 0.5, and FDR, 0.02, respectively). Further analysis of females revealed that only young female mice were not different (β diversity) post-CLP day 14 to controls. CONCLUSION Although sepsis-induced perturbations of the intestinal microbiota occur initially in both male and female C57BL/6 mice, females demonstrate different microbiota by day 14. This may be seen primarily in younger females. This difference in recovery may play a role in outcome differences between sexes after sepsis.
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Affiliation(s)
- Philip Alexander Efron
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Dijoia B. Darden
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Eric C. Li
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Jennifer Munley
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Lauren Kelly
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Brittany Fenner
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Dina C. Nacionales
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Ricardo F. Ungaro
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Marvin L. Dirain
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Jaimar Rincon
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Robert T. Mankowski
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Christiaan Leeuwenburgh
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Fredrick A. Moore
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Scott C. Brakenridge
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Thomas C. Foster
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Orlando Laitano
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Gemma Casadesus
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Lyle L. Moldawer
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Alicia M. Mohr
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Ryan M. Thomas
- From the Department of Surgery (P.A.E., D.B.D., J.M., L.K., B.F., D.C.N., R.F.U., M.L.D., J.R., F.A.M., S.C.B., L.L.M., A.M.M., R.M.T.), Department of Aging and Geriatric Research (P.A.E., R.T.M., C.L.), Department of Medicine (E.C.L.), and Division of Infectious Diseases and Global Medicine, Department of Neuroscience (T.C.F.), University of Florida College of Medicine, Gainesville; Department of Nutrition and Integrative Physiology (O.L.), Florida State University College of Health and Human Sciences, Tallahassee; Department of Pharmacology and Therapeutics (G.C.), College of Medicine, and Department of Molecular Genetics and Microbiology (R.M.T.), University of Florida; and Section of General Surgery (R.M.T.); North Florida/South Georgia Veterans Health System, Gainesville, Florida
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25
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Oami T, Imaeda T, Nakada TA, Abe T, Takahashi N, Yamao Y, Nakagawa S, Ogura H, Shime N, Umemura Y, Matsushima A, Fushimi K. Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database. J Intensive Care 2022; 10:33. [PMID: 35836301 PMCID: PMC9281011 DOI: 10.1186/s40560-022-00624-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/01/2022] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined. Methods We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs. Results Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = − $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = − $1806/year [95% CI − $2432 to − $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs. Conclusions We demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00624-5.
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Affiliation(s)
- Takehiko Oami
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Taro Imaeda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
| | - Toshikazu Abe
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.,Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Nozomi Takahashi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Yasuo Yamao
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Satoshi Nakagawa
- Department of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Asako Matsushima
- Department of Emergency & Critical Care, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
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26
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Wang G, Jiang C, Fang J, Li Z, Cai H. Pentraxin-3 as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis. Crit Care 2022; 26:167. [PMID: 35676730 PMCID: PMC9175505 DOI: 10.1186/s13054-022-04032-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to clarify the prognostic value of Pentraxin-3 (PTX3) on the mortality of patients with sepsis. METHODS Publications published up to January 2021 were retrieved from PubMed, EMBASE, and the Cochrane library. Data from eligible cohort and case-control studies were extracted for the meta-analysis. Multivariate regression analysis was used to evaluate the correlation of the outcomes with sample size and male proportion. RESULTS A total of 17 studies covering 3658 sepsis patients were included. PTX3 level was significantly higher in non-survivor compared to survivor patients (SMD (95% CI): -1.06 (-1.43, -0.69), P < 0.001). Increased PTX3 level was significantly associated with mortality (HR (95% CI): 2.09 (1.55, 2.81), P < 0.001). PTX3 showed good predictive capability for mortality (AUC:ES (95% CI): 0.73 (0.70, 0.77), P < 0.001). The outcome comparing PTX3 level in non-survivors vs. survivors and the outcome of the association between PTX3 and mortality were associated with sample size but not male proportion. AUC was associated with both sample size and male proportion. CONCLUSIONS PTX3 level was significantly higher in non-survivor compared to survivor patients with sepsis. Elevated PTX3 level was significantly associated with mortality. Furthermore, the level of PTX3 might predict patient mortality.
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Affiliation(s)
- Guobin Wang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Chunyan Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Junjun Fang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Zhitao Li
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Hongliu Cai
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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27
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A Tale of Two ICUs: One for Women and One for Men? Crit Care Med 2022; 50:1012-1015. [PMID: 35612440 DOI: 10.1097/ccm.0000000000005538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Jirak P, Mirna M, Van Almsick V, Shomanova Z, Mahringer M, Lichtenauer M, Kopp K, Topf A, Sieg F, Kraus J, Gharibeh SX, Hoppe UC, Fiedler L, Larbig R, Pistulli R, Motloch LJ, Dieplinger AM. Gender-Specific Differences in the Intensive Care Treatment of COVID-19 Patients. J Pers Med 2022; 12:jpm12050849. [PMID: 35629271 PMCID: PMC9146781 DOI: 10.3390/jpm12050849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Gender-specific differences in the outcome of COVID-19 patients requiring intensive care treatment have been reported. However, a potential association with ICU therapy remains elusive. Methods: A total of 224 consecutive patients (63 women) treated for severe COVID-19 disease requiring mechanical ventilation were screened for the study. After propensity score matching for gender, 40 men and 40 women were included in the study. Comparative analysis was conducted for laboratory parameters, ICU therapy and complications (pulmonary embolism, thrombosis, stroke, and ventricular arrhythmias), and outcome (mortality). Results: Male patients had significantly higher levels of CRP (p = 0.012), interleukin-6 (p = 0.020) and creatinine (p = 0.027), while pH levels (p = 0.014) were significantly lower compared to females. Male patients had longer intubation times (p = 0.017), longer ICU stays (p = 0.022) and higher rates of catecholamine dependence (p = 0.037). Outcome, complications and ICU therapy did not differ significantly between both groups. Conclusion: The present study represents the first matched comparison of male and female COVID-19 patients requiring intensive care treatment. After propensity matching, male patients still displayed a higher disease severity. This was reflected in higher rates of vasopressors, duration of ICU stay and duration of intubation. In contrast, no significant differences were observed in mortality rates, organ replacement therapy and complications during ICU stay.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
- Correspondence:
| | - Moritz Mirna
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Vincent Van Almsick
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany; (V.V.A.); (Z.S.); (R.P.)
| | - Zornitsa Shomanova
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany; (V.V.A.); (Z.S.); (R.P.)
| | - Magdalena Mahringer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Michael Lichtenauer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Kristen Kopp
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Albert Topf
- Clinic for Internal Medicine, Hospital Villach, 9500 Villach, Austria;
| | - Franz Sieg
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Johannes Kraus
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Sarah X. Gharibeh
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Uta C. Hoppe
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Lukas Fiedler
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
- Department of Internal Medicine II, Wiener Neustadt Hospital, 2700 Wiener Neustadt, Austria
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, 41063 Mönchengladbach, Germany;
- Department of Cardiology II-Electrophysiology, University Hospital Muenster, 48149 Muenster, Germany
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany; (V.V.A.); (Z.S.); (R.P.)
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.M.); (M.M.); (M.L.); (K.K.); (F.S.); (J.K.); (S.X.G.); (U.C.H.); (L.F.); (L.J.M.)
| | - Anna-Maria Dieplinger
- Nursing Science Programme, Institute for Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria;
- Medical Faculty, Johannes Kepler University Linz, 4040 Linz, Austria
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29
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Zhang J, Liu W, Shi W, Cui X, Liu Y, Lu Z, Xiao W, Hua T, Yang M. A Nomogram With Six Variables Is Useful to Predict the Risk of Acquiring Carbapenem-Resistant Microorganism Infection in ICU Patients. Front Cell Infect Microbiol 2022; 12:852761. [PMID: 35402310 PMCID: PMC8990894 DOI: 10.3389/fcimb.2022.852761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Carbapenem-resistant microorganism (CRO) transmission in the medical setting confers a global threat to public health. However, there is no established risk prediction model for infection due to CRO in ICU patients. This study aimed to develop a nomogram to predict the risk of acquiring CRO infection in patients with the first ICU admission and to determine the length of ICU stay (ICU-LOS) and 28-day survival. Methods Patient data were retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) database based on predetermined inclusion and exclusion criteria. A CRO was defined as a bacterium isolated from any humoral microbial culture that showed insensitivity or resistance to carbapenems. The characteristics of CRO and non-CRO patients in the first ICU admission were compared. Propensity score matching was applied to balance the differences between the CRO and non-CRO cohorts. Kaplan–Meier curves were constructed to determine the 28-day survival rate and ICU-LOS. Furthermore, after randomization of the CRO cohort into the training and validation sets, a predictive nomogram was constructed based on LASSO regression and Logistic regression analysis, and its performance was verified by internal validation. Results Overall, 4531 patients who had first ICU admission as recorded in MIMIC-IV were enrolled, 183 (4.04%) of whom were diagnosed with CRO infection. Moreover, CRO infection was independently associated with 28-day survival and ICU-LOS in ICU patients. Parameters eligible for inclusion in this nomogram were male sex, hemoglobin-min, temperature-max, use of a peripherally inserted central catheter line, dialysis treatment, and use of carbapenems. This nomogram showed a better performance as indicated by the area under the receiver operating characteristic curve values of 0.776 (95% confidence interval [CI] 0.667-0.750) and 0.723 (95% CI 0.556-0.855) in the training and validation sets, respectively, in terms of predicting the risk of acquiring CRO infection. Conclusions CRO infection was independently associated with ICU-LOS and 28-day survival in patients with first ICU admission. The nomogram showed the best prediction of the risk of acquiring CRO infection in ICU patients. Based on the nomogram-based scoring, we can management the risk factors and guide individualized prevention and control of CRO.
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Affiliation(s)
- Jin Zhang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanjun Liu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Shi
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuanxuan Cui
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing and Signal Processing, Ministry of Education, Anhui University, Hefei, China
| | - Zongqing Lu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Min Yang,
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Donor-recipient sex is associated with transfusion-related outcomes in critically ill patients. Blood Adv 2022; 6:3260-3267. [PMID: 35286383 PMCID: PMC9198942 DOI: 10.1182/bloodadvances.2021006402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Transfusion of female RBCs to male recipients increases the risk of ICU mortality compared with female blood to female recipients. Receiving RBCs from female donors is associated with a trend toward ARDS.
Transfusion of red blood cells (RBCs) from female donors has been associated with increased risk of mortality. This study aims to investigate the associations between donor-recipient sex and posttransfusion mortality and morbidity in critically ill patients who received RBC transfusions from either male-only donors or from female-only donors (unisex-transfusion cases). Survival analysis was used to compare 4 groups: female-to-female, female-to-male, male-to-female, and male-to-male transfusion. Multivariate logistic model was used to evaluate the association between donor sex and intensive care unit (ICU) mortality. Associations between transfusion and acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and nosocomial infections were assessed. Of the 6992 patients included in the original cohort study, 403 patients received unisex-transfusion. Survival analysis and the logistic model showed that transfusion of female RBCs to male patients was associated with an increased ICU mortality compared with transfusion of female RBCs to female patients (odds ratio, 2.43; 95% confidence interval, 1.02-5.77; P < .05). There was a trend toward increased ARDS in patients receiving RBC from female donors compared with those receiving blood from males (P = .06), whereas AKI was higher in donor-recipient sex-matched transfusion groups compared with sex-mismatched groups (P = .05). This was an exploratory study with potential uncontrolled confounders that limits broad generalization of the findings. Results warrant further studies investigating biological mechanisms underlying the association between donor sex with adverse outcomes as well as studies on the benefit of matching of blood between donor and recipient.
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Yang HY, Hsu YSO, Lee TH, Wu CY, Tsai CY, Chou LF, Tu HT, Huang YT, Chang SH, Yen CL, Hsieh MH, Lee CC, Kuo G, Hsiao CY, Lin HL, Chen JJ, Yen TH, Chen YC, Tian YC, Yang CW, Anderson GF. Reduced Risk of Sepsis and Related Mortality in Chronic Kidney Disease Patients on Xanthine Oxidase Inhibitors: A National Cohort Study. Front Med (Lausanne) 2022; 8:818132. [PMID: 35174186 PMCID: PMC8841527 DOI: 10.3389/fmed.2021.818132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Advanced chronic kidney disease (CKD) patients are at higher risk of sepsis-related mortality following infection and bacteremia. Interestingly, the urate-lowering febuxostat and allopurinol, both xanthine oxidase inhibitors (XOis), have been suggested to influence the sepsis course in animal studies. In this study, we aim to investigate the relationship between XOis and infection/sepsis risk in pre-dialysis population. Methods Pre-dialysis stage 5 CKD patients with gout were identified through the National Health Insurance Research Database (NHIRD) in Taiwan from 2012 to 2016. Outcomes were also compared with national data. Results In our nationwide, population-based cohort study, 12,786 eligible pre-dialysis stage 5 CKD patients were enrolled. Compared to non-users, febuxostat users and allopurinol users were associated with reduced sepsis/infection risk [hazard ratio (HR), 0.93; 95% confidence interval (CI), 0.87–0.99; P = 0.0324 vs. HR, 0.92; 95% CI, 0.86–0.99; P = 0.0163]. Significant sepsis/infection-related mortality risk reduction was associated with febuxostat use (HR, 0.68; 95% CI, 0.52–0.87). Subgroup analysis demonstrated preference of febuxostat over allopurinol in sepsis/infection-related mortality among patients younger than 65 years of age, stain users, non-steroidal anti-inflammatory drug non-users, and non-diabetics. There was no significant difference in major adverse cardiac and cerebrovascular event (MACCE) risk between users and non-users while reduced risk of all-cause mortality was observed for XOi users. Conclusions Use of XOi in pre-dialysis stage 5 CKD patients may be associated with reduced risk of sepsis/infection and their related mortality without increased MACCE and overall mortality.
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Affiliation(s)
- Huang-Yu Yang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yun-Shiuan Olivia Hsu
- Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tao Han Lee
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Ying Tsai
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Li-Fang Chou
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hui-Tzu Tu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Hung Chang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital at Linkou, Chang Gung University School of Medicine, Taoyuan, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Meng-Hsuan Hsieh
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - George Kuo
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Hsing-Lin Lin
- Division of Critical Care Surgery, Department of Critical Care Medicine, Veterans General Hospital, Kaohsiung, Taiwan
| | - Jia-Jin Chen
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ya-Chong Tian
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Wei Yang
- Nephrology Department, Kidney Research Institute, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Gerard F. Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- *Correspondence: Gerard F. Anderson
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Jeanselme V, De-Arteaga M, Zhang Z, Barrett J, Tom B. Imputation Strategies Under Clinical Presence: Impact on Algorithmic Fairness. PROCEEDINGS OF MACHINE LEARNING RESEARCH 2022; 193:12-34. [PMID: 36601036 PMCID: PMC7614014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Biases have marked medical history, leading to unequal care affecting marginalised groups. The patterns of missingness in observational data often reflect these group discrepancies, but the algorithmic fairness implications of group-specific missingness are not well understood. Despite its potential impact, imputation is too often an overlooked preprocessing step. When explicitly considered, attention is placed on overall performance, ignoring how this preprocessing can reinforce groupspecific inequities. Our work questions this choice by studying how imputation affects downstream algorithmic fairness. First, we provide a structured view of the relationship between clinical presence mechanisms and groupspecific missingness patterns. Then, through simulations and real-world experiments, we demonstrate that the imputation choice influences marginalised group performance and that no imputation strategy consistently reduces disparities. Importantly, our results show that current practices may endanger health equity as similarly performing imputation strategies at the population level can affect marginalised groups differently. Finally, we propose recommendations for mitigating inequities that may stem from a neglected step of the machine learning pipeline.
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Affiliation(s)
| | - Maria De-Arteaga
- McCombs School of Business, University of Texas at Austin, Austin, USA
| | - Zhe Zhang
- Rady School of Management, University of California, San Diego, USA
| | - Jessica Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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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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Jones LC, Dion C, Efron PA, Price CC. Sepsis and Cognitive Assessment. J Clin Med 2021; 10:4269. [PMID: 34575380 PMCID: PMC8470110 DOI: 10.3390/jcm10184269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022] Open
Abstract
Sepsis disproportionally affects people over the age of 65, and with an exponentially increasing older population, sepsis poses additional risks for cognitive decline. This review summarizes published literature for (1) authorship qualification; (2) the type of cognitive domains most often assessed; (3) timelines for cognitive assessment; (4) the control group and analysis approach, and (5) sociodemographic reporting. Using key terms, a PubMed database review from January 2000 to January 2021 identified 3050 articles, and 234 qualified as full text reviews with 18 ultimately retained as summaries. More than half (61%) included an author with an expert in cognitive assessment. Seven (39%) relied on cognitive screening tools for assessment with the remaining using a combination of standard neuropsychological measures. Cognitive domains typically assessed were declarative memory, attention and working memory, processing speed, and executive function. Analytically, 35% reported on education, and 17% included baseline (pre-sepsis) data. Eight (44%) included a non-sepsis peer group. No study considered sex or race/diversity in the statistical model, and only five studies reported on race/ethnicity, with Caucasians making up the majority (74%). Of the articles with neuropsychological measures, researchers report acute with cognitive improvement over time for sepsis survivors. The findings suggest avenues for future study designs.
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Affiliation(s)
- Laura C. Jones
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA; (L.C.J.); (C.D.)
- Perioperative Cognitive Anesthesia Network, Department of Anesthesia University of Florida, Gainesville, FL 32610, USA
| | - Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA; (L.C.J.); (C.D.)
- Perioperative Cognitive Anesthesia Network, Department of Anesthesia University of Florida, Gainesville, FL 32610, USA
| | - Philip A. Efron
- Department of Surgery, University of Florida, Gainesville, FL 32610, USA;
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA; (L.C.J.); (C.D.)
- Perioperative Cognitive Anesthesia Network, Department of Anesthesia University of Florida, Gainesville, FL 32610, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL 32610, USA
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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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Application of Machine Learning Methods on Patient Reported Outcome Measurements for Predicting Outcomes: A Literature Review. INFORMATICS 2021. [DOI: 10.3390/informatics8030056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The field of patient-centred healthcare has, during recent years, adopted machine learning and data science techniques to support clinical decision making and improve patient outcomes. We conduct a literature review with the aim of summarising the existing methodologies that apply machine learning methods on patient-reported outcome measures datasets for predicting clinical outcomes to support further research and development within the field. We identify 15 articles published within the last decade that employ machine learning methods at various stages of exploiting datasets consisting of patient-reported outcome measures for predicting clinical outcomes, presenting promising research and demonstrating the utility of patient-reported outcome measures data for developmental research, personalised treatment and precision medicine with the help of machine learning-based decision-support systems. Furthermore, we identify and discuss the gaps and challenges, such as inconsistency in reporting the results across different articles, use of different evaluation metrics, legal aspects of using the data, and data unavailability, among others, which can potentially be addressed in future studies.
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Chen L, Kraft BD, Roggli VL, Healy ZR, Woods CW, Tsalik EL, Ginsburg GS, Murdoch DM, Suliman HB, Piantadosi CA, Welty-Wolf KE. Heparin-based blood purification attenuates organ injury in baboons with Streptococcus pneumoniae pneumonia. Am J Physiol Lung Cell Mol Physiol 2021; 321:L321-L335. [PMID: 34105359 DOI: 10.1152/ajplung.00337.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Bacterial pneumonia is a major cause of morbidity and mortality worldwide despite the use of antibiotics, and novel therapies are urgently needed. Building on previous work, we aimed to 1) develop a baboon model of severe pneumococcal pneumonia and sepsis with organ dysfunction and 2) test the safety and efficacy of a novel extracorporeal blood filter to remove proinflammatory molecules and improve organ function. After a dose-finding pilot study, 12 animals were inoculated with Streptococcus pneumoniae [5 × 109 colony-forming units (CFU)], given ceftriaxone at 24 h after inoculation, and randomized to extracorporeal blood purification using a filter coated with surface-immobilized heparin sulfate (n = 6) or sham treatment (n = 6) for 4 h at 30 h after inoculation. For safety analysis, four uninfected animals also underwent purification. At 48 h, necropsy was performed. Inoculated animals developed severe pneumonia and septic shock. Compared with sham-treated animals, septic animals treated with purification displayed significantly less kidney injury, metabolic acidosis, hypoglycemia, and shock (P < 0.05). Purification blocked the rise in peripheral blood S. pneumoniae DNA, attenuated bronchoalveolar lavage (BAL) CCL4, CCL2, and IL-18 levels, and reduced renal oxidative injury and classical NLRP3 inflammasome activation. Purification was safe in both uninfected and infected animals and produced no adverse effects. We demonstrate that heparin-based blood purification significantly attenuates levels of circulating S. pneumoniae DNA and BAL cytokines and is renal protective in baboons with severe pneumococcal pneumonia and septic shock. Purification was associated with less severe acute kidney injury, metabolic derangements, and shock. These results support future clinical studies in critically ill septic patients.
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Affiliation(s)
- Lingye Chen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
| | - Bryan D Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham Department of Veterans Affairs Medical Center, Durham, North Carolina.,Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Zachary R Healy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
| | - Christopher W Woods
- Durham Department of Veterans Affairs Medical Center, Durham, North Carolina.,Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ephraim L Tsalik
- Durham Department of Veterans Affairs Medical Center, Durham, North Carolina.,Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Geoffrey S Ginsburg
- Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - David M Murdoch
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
| | - Hagir B Suliman
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Claude A Piantadosi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham Department of Veterans Affairs Medical Center, Durham, North Carolina.,Department of Pathology, Duke University Medical Center, Durham, North Carolina.,Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Karen E Welty-Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
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Wasyluk W, Wasyluk M, Zwolak A. Sepsis as a Pan-Endocrine Illness-Endocrine Disorders in Septic Patients. J Clin Med 2021; 10:jcm10102075. [PMID: 34066289 PMCID: PMC8152097 DOI: 10.3390/jcm10102075] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022] Open
Abstract
Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". One of the elements of dysregulated host response is an endocrine system disorder. Changes in its functioning in the course of sepsis affect almost all hormonal axes. In sepsis, a function disturbance of the hypothalamic-pituitary-adrenal axis has been described, in the range of which the most important seems to be hypercortisolemia in the acute phase. Imbalance in the hypothalamic-pituitary-thyroid axis is also described. The most typical manifestation is a triiodothyronine concentration decrease and reverse triiodothyronine concentration increase. In the somatotropic axis, a change in the secretion pattern of growth hormone and peripheral resistance to this hormone has been described. In the hypothalamic-pituitary-gonadal axis, the reduction in testosterone concentration in men and the stress-induced "hypothalamic amenorrhea" in women have been described. Catecholamine and β-adrenergic stimulation disorders have also been reported. Disorders in the endocrine system are part of the "dysregulated host response to infection". They may also affect other components of this dysregulated response, such as metabolism. Hormonal changes occurring in the course of sepsis require further research, not only in order to explore their potential significance in therapy, but also due to their promising prognostic value.
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Affiliation(s)
- Weronika Wasyluk
- Chair of Internal Medicine and Department of Internal Medicine in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland;
- Doctoral School, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence:
| | - Martyna Wasyluk
- Student’s Scientific Association at Chair of Internal Medicine and Department of Internal Medicine in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Agnieszka Zwolak
- Chair of Internal Medicine and Department of Internal Medicine in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland;
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Shepherd R, Cheung AS, Pang K, Saffery R, Novakovic B. Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics. Front Immunol 2021; 11:604000. [PMID: 33584674 PMCID: PMC7873844 DOI: 10.3389/fimmu.2020.604000] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Sexual dimorphism refers to differences between biological sexes that extend beyond sexual characteristics. In humans, sexual dimorphism in the immune response has been well demonstrated, with females exhibiting lower infection rates than males for a variety of bacterial, viral, and parasitic pathogens. There is also a substantially increased incidence of autoimmune disease in females compared to males. Together, these trends indicate that females have a heightened immune reactogenicity to both self and non-self-molecular patterns. However, the molecular mechanisms driving the sexually dimorphic immune response are not fully understood. The female sex hormones estrogen and progesterone, as well as the male androgens, such as testosterone, elicit direct effects on the function and inflammatory capacity of immune cells. Several studies have identified a sex-specific transcriptome and methylome, independent of the well-described phenomenon of X-chromosome inactivation, suggesting that sexual dimorphism also occurs at the epigenetic level. Moreover, distinct alterations to the transcriptome and epigenetic landscape occur in synchrony with periods of hormonal change, such as puberty, pregnancy, menopause, and exogenous hormone therapy. These changes are also mirrored by changes in immune cell function. This review will outline the evidence for sex hormones and pregnancy-associated hormones as drivers of epigenetic change, and how this may contribute to the sexual dimorphism. Determining the effects of sex hormones on innate immune function is important for understanding sexually dimorphic autoimmune diseases, sex-specific responses to pathogens and vaccines, and how innate immunity is altered during periods of hormonal change (endogenous or exogenous).
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Affiliation(s)
- Rebecca Shepherd
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Ken Pang
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Brain and Mitochondrial Research, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Richard Saffery
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Boris Novakovic
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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Wernly B, Bruno RR, Mamandipoor B, Jung C, Osmani V. Sex-specific outcomes and management in critically ill septic patients. Eur J Intern Med 2021; 83:74-77. [PMID: 33059966 DOI: 10.1016/j.ejim.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Female and male critically ill septic patients might differ with regards to risk distribution, management, and outcomes. We aimed to compare male versus female septic patients in a large collective with regards to baseline risk distribution and outcomes. METHODS In total, 17,146 patients were included in this analysis, 8781 (51%) male and 8365 (49%) female patients. The primary endpoint was ICU-mortality. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analyses were used to assess sex-specific differences. RESULTS Female patients had lower SOFA scores (5 ± 5 vs. 6 ± 6; p<0.001) and creatinine (1.20±1.35 vs. 1.40±1.54; p<0.001). In the total cohort, the ICU mortality was 10% and similar between female and male (10% vs. 10%; p = 0.34) patients. The ICU remained similar between sexes after adjustment in model-1 (aOR 1.05 95% CI 0.95-1.16; p = 0.34); model-2 (aOR 0.91 95% CI 0.79-1.05; p = 0.18) and model-3 (aOR 0.93 95% CI 0.80-1.07; p = 0.29). In sensitivity analyses, no major sex-specific differences in mortality could be detected. CONCLUSION In this study no clinically relevant sex-specific mortality differences could be detected in critically ill septic patients. Possible subtle gender differences could play a minor role in the acute situation due to the severity of the disease in septic patients.
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Affiliation(s)
- Bernhard Wernly
- Paracelsus Medical University of Salzburg, Austria, Department of Cardiology, Clinic of Internal Medicine II, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Raphael Romano Bruno
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Germany
| | | | - Christian Jung
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Germany
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy
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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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What's New in Shock, August 2019? Shock 2019; 52:143-145. [PMID: 31306304 DOI: 10.1097/shk.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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