Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Modra, Lucy; Higgins, Alisa; Abeygunawardana, Vihangi; Vithanage, Ruvini N; Bailey, Michael; Bellomo, Rinaldo

doi:10.1097/ccm.0000000000005469

Cited by 35 publications

(40 citation statements)

References 52 publications

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“…The fact that the increased ICU mortality trend in relation to severity of illness in our study was no longer evident indicates that this trend is explainable by the admission of more severely ill patients over the years—which particularly affects the female population given their higher ICU mortality observed. Consistent with published literature, men with AMI in our study were also more frequently referred to reperfusion therapies and received more often organ support upon ICU admission and during ICU stay than women, including mechanical ventilation and vasoactive medication [ 34 , 42 ]. This phenomenon is known as the ‘Yentl Syndrome’ [ 43 ] and might be particularly pronounced in younger women [ 44 ].…”

Section: Discussionsupporting

confidence: 86%

Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

et al. 2023

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Background Timely management of acute myocardial infarction (AMI) and acute stroke has undergone impressive progress during the last decade. However, it is currently unknown whether both sexes have profited equally from improved strategies. We sought to analyze sex-specific temporal trends in intensive care unit (ICU) admission and mortality in younger patients presenting with AMI or stroke in Switzerland. Methods Retrospective analysis of temporal trends in 16,954 younger patients aged 18 to ≤ 52 years with AMI or acute stroke admitted to Swiss ICUs between 01/2008 and 12/2019. Results Over a period of 12 years, ICU admissions for AMI decreased more in women than in men (− 6.4% in women versus − 4.5% in men, p < 0.001), while ICU mortality for AMI significantly increased in women (OR 1.2 [1.10–1.30], p = 0.032), but remained unchanged in men (OR 0.99 [0.94–1.03], p = 0.71). In stroke patients, ICU admission rates increased between 3.6 and 4.1% per year in both sexes, while ICU mortality tended to decrease only in women (OR 0.91 [0.85–0.95, p = 0.057], but remained essentially unaltered in men (OR 0.99 [0.94–1.03], p = 0.75). Interventions aimed at restoring tissue perfusion were more often performed in men with AMI, while no sex difference was noted in neurovascular interventions. Conclusion Sex and gender disparities in disease management and outcomes persist in the era of modern interventional neurology and cardiology with opposite trends observed in younger stroke and AMI patients admitted to intensive care. Although our study has several limitations, our data suggest that management and selection criteria for ICU admission, particularly in younger women with AMI, should be carefully reassessed. Graphical Abstract

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Section: Discussionsupporting

confidence: 86%

Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

et al. 2023

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“…No difference has been reported in the incidence of sepsis-associated acute kidney injury in men and women [ 68 ]. However, a meta-analysis of 21 studies including a total of 545,538 participants revealed that females were less likely to receive renal replacement therapy compared with males (adjusted OR 0.81 [0.73–0.89], I 2 = 57.4%) [ 69 ].…”

Section: Clinical Studiesmentioning

confidence: 99%

Interactions between Gender and Sepsis—Implications for the Future

et al. 2023

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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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“…Additionally, the authors were not able to account for death as a competing risk when assessing the probability of receiving ICU resources. As Modra et al (8) previously showed, women are more likely to die in the ICU (10); such deaths shorten their ICU lengths of stay, resulting in less time in which mechanical ventilation or renal replacement therapy can be initiated.…”

mentioning

confidence: 95%

“…Modra et al (8) found that across a wide range of ICU patients, sex was associated with differential resource use even after adjusting for patient-level severity of illness and age. This is a necessary first step to identify that disparity exists between men and women in critical care practices.…”

mentioning

confidence: 99%

“…Finally, both sex-based goals of care differences and bias (implicit or explicit) may limit admission to the ICU itself. Once admitted to the ICU, we expect utilization of life support will be based on severity of illness, disease processes, and patient wishes, not sex; however, as Modra et al (8) demonstrate, this may not be the case. What about decisions upstream?…”

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confidence: 99%

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A Tale of Two ICUs: One for Women and One for Men?*

Chen

Gershengorn

2022

Critical Care Medicine

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informed by these two complementary fields of expertise every step of the way. We call this approach MEDucation because each discipline is afforded complementary context from the other and the family is no longer seen as the interpreter for the child's needs.Tomaszewski et al ( 7) should be congratulated on their study. They have been successful in chartering new territory regarding the educational outcomes of children who survive critical illness. In addition, they have shown us that there is a real need for disciplines to come together to assure that life after the ICU meets the longterm outcomes in both the realms of health and education. Finally, a realization that this type of evaluation, with transdisciplinary partners, like pediatricians, therapists, and education professionals, is needed to ensure that the potential of the child and family are realized.

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Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Cited by 35 publications

References 52 publications

Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

Interactions between Gender and Sepsis—Implications for the Future

A Tale of Two ICUs: One for Women and One for Men?*

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