Sex as a prognostic factor for mortality in critically ill adults with sepsis : A systematic review and meta-analysis
Antequera, Alba (Institut d'Investigació Biomèdica Sant Pau)
Lopez-Alcalde, Jesus (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Stallings, E. (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Muriel, Alfonso (Universidad de Alcalá)
Fernández-Félix, Borja (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
del Campo, Rosa (Hospital Universitario Ramón y Cajal (Madrid))
Ponce-Alonso, Manuel (Hospital Universitario Ramón y Cajal (Madrid))
Fidalgo, P. (Hospital Universitario del Henares ( Madrid))
Halperin, Ana Verónica (Hospital Universitario Ramón y Cajal (Madrid))
Madrid-Pascual, Olaya (Arztpraxis Kalkbreite)
Álvarez-Díaz, Noelia (Hospital Universitario Ramón y Cajal (Madrid))
Solà, Ivan (Institut d'Investigació Biomèdica Sant Pau)
Gordo Vidal, Federico (Hospital Universitario del Henares ( Madrid))
Urrútia, Gerard (Institut d'Investigació Biomèdica Sant Pau)
Zamora, Javier (University of Birmingham. Institute of Metabolism and Systems Research.)

Date:	2021
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.
Grants:	Instituto de Salud Carlos III CM18/00141 Instituto de Salud Carlos III CM19/00069 Ministerio de Economía y Competitividad PIE16/00050
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Adult ; Critical Illness ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Prognosis ; Sepsis
Published in:	BMJ open, Vol. 11 Núm. 9 (September 2021) , p. e048982, ISSN 2044-6055

DOI: 10.1136/bmjopen-2021-048982
PMID: 34551945

11 p, 1.3 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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