Sex and critical illness

Fowler, Robert; Filate, Woganee A; Hartleib, Michael; Frost, David; Lazongas, Chris; Hladunewich, Michelle A.

doi:10.1097/mcc.0b013e3283307a12

Cited by 26 publications

(25 citation statements)

References 95 publications

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“…The number of men admitted to the ICU was considerably higher than women. This finding is suggested by many countries where men are more commonly admitted to the ICU and are more likely to receive more aggressive support than women (10) .…”

Section: Discussionmentioning

confidence: 58%

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

Freitas

2010

Rev. Latino-Am. Enfermagem

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This study aimed to understand the profile and severity of patients in physiotherapy treatment after their admission to the intensive care unit (ICU) by applying the APACHE II index. One hundred and forty six subjects, with a mean age of 60.5 ± 19.2 years, were evaluated. The APACHE II index was applied in the first 24 hours to evaluate the severity and mortality risk score. Patients were monitored until hospital discharge or death. The mean APACHE II score was 20±7.3 with an estimated risk of death of 32.4% and observed mortality of 58.2%. The mean hospital stay was 27.8±25.2 days. The patients in physiotherapy at the institution studied were predominantly male, elderly, from the emergency service for treatment (non-surgical), and had clear severity, suggested by the APACHE II score and the observed mortality.Descriptors: APACHE; Mortality; Intensive Care Units. Perfil y gravedad de los pacientes de las unidades de terapia intensiva: aplicación prospectiva del puntaje APACHE IIEste estudio tuvo como objetivo conocer el perfil y la gravedad de pacientes asistidos por la fisioterapia, después de su ingreso en las unidades de terapia intensiva (UTI), a través de la aplicación del puntaje APACHE II. Se evaluaron 146 individuos con promedio de edad de 60,5±19,2 años. El puntaje APACHE II fue aplicado en las primeras 24h para evaluar la gravedad y dar puntuación al riesgo de mortalidad. Los pacientes fueron acompañados hasta el momento del alta hospitalaria o de la muerte. El puntaje APACHE II promedio fue de 20±7,3 con riesgo estimado de muerte de 32,4% y mortalidad observada de 58,2%. El promedio de permanencia hospitalaria fue de 27,8±25,2 días.En los pacientes asistidos por la fisioterapia de la institución investigada, el predominio fue del sexo masculino, ancianos, provenientes de la atención rápida para tratamiento clínico (no quirúrgico) y que presentan nítida gravedad, sugerida por el puntaje APACHE II y por la mortalidad observada.

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Section: Discussionmentioning

confidence: 58%

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

Freitas

2010

Rev. Latino-Am. Enfermagem

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“…However, this was not likely to bias our results because the differences in mortality rates were sex independent. In other studies, data about sex based differences in mortality rates have been inconclusive [27][28][29][30]. In a mixed medical-surgical ICU population, huge amounts of CK can be released into the circulation due to, for example, trauma, resulting in a temporary increase of the serum CK concentration.…”

Section: Discussionmentioning

confidence: 96%

Low serum creatine kinase activity is associated with worse outcome in critically ill patients

Moortel

Speeckaert

Fiers

et al. 2014

Journal of Critical Care

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“…The male preponderance and poorer prognosis status were found not only for respiratory diseases but also for most acute inflammatory processes. Several studies from various countries suggested that males, children as well as adults, were more frequently admitted to intensive care units than females and, thus, more likely to require aggressive life support [18,38]. In a recent work on predictors of sequelae and death following bacterial meningitis in childhood, male gender was reported to be a significant prognostic factor, with no satisfactory explanation found [39].…”

Section: Reviewmentioning

confidence: 99%

Sex and inflammation in respiratory diseases: a clinical viewpoint

et al. 2013

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This review discusses sex differences in the prognosis of acute or chronic inflammatory diseases. The consequences of severe inflammation vary in relation to sex, depending on illness duration. In the majority of acute diseases, males present higher mortality rates, whereas continuous chronic inflammation associated with tissue damage is more deleterious in females. The recruitment of cells, along with its clinical expression, is more significant in females, as reflected by higher inflammatory markers. Given that estrogens or androgens are known to modulate inflammation, their different levels in males and females cannot account for the sexual dimorphism observed in humans and animals from birth to death with regard to inflammation. Numerous studies evaluated receptors, cytokine production, and clinical outcomes in both animals and humans, revealing that estrogens clearly modulate the immune response, but the results are contradictory and difficult to link to hormone concentrations. Even in prepubescent children, the presentation of acute pneumonia or chronic diseases mimics the adult pattern. Several genes located on the X chromosome have been shown to encode molecules involved in inflammation. Moreover, 10% to 15% of the genes from silenced X chromosome may escape inhibition. Females are also a mosaic of cells with genes from either paternal or maternal X chromosome. Therefore, polymorphism of X-linked genes would result in the presence of two cell populations with distinct regulatory arsenals, providing females with greater diversity to fight against infectious challenges, in comparison with the uniform cell populations in hemizygous males. The similarities observed between males and Turner syndrome patients using an endotoxin stimulation model support the difference in gene expression between monosomy and disomy for the X chromosome. Considering the enhanced inflammation in females, cytokine production may be assumed to be higher in females than males. Even if all results are not clear-cut, nonetheless, many studies have reported higher cytokine levels in both male humans and animals than in females. High IL-6 levels in males correlated with poorer prognosis and shorter longevity. A sound understanding of the basic regulatory mechanisms responsible for these gender differences may lead to new therapeutic targets.

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Sex and critical illness

Abstract: Sex differences in incidence of critical illness and provision of care exist but it is unclear whether they relate to differences in risk factors, or differences in decision-making among patients, surrogates or healthcare professionals.

Cited by 26 publications

References 95 publications

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

Low serum creatine kinase activity is associated with worse outcome in critically ill patients

Sex and inflammation in respiratory diseases: a clinical viewpoint

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