Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis.
Autor: Antequera, Alba; López Alcalde, Jesús; Stallings, Elena; Muriel, Alfonso; Fernández Félix, Borja; Del Campo, Rosa; Ponce Alonso, Manuel; Fidalgo, Pilar; Halperin, Ana Verónica; Madrid Pascual, Olaya; Álvarez Díaz, Noelia; Solá, Iván; Gordo Vidal, Federico; Urrutia, Gerard; Zamora, Javier
Resumen: 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.
Identificador universal: http://hdl.handle.net/10641/2847
Fecha: 2021
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