Increased female mortality after ICU admission and its potential causes.
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1 Increased female mortality after ICU admission and its potential causes. L. Mardini, J. Lipes, D. Jayaraman McGill University CCCF 2012 Oral presentations session October 29 th 2012
2 Increased female mortality after ICU admission and its potential causes. No financial Disclosure.
3 Outline Background Our project Results Conclusions Questions
4 Background Female sex is associated with increased mortality in the ICU
5 i. Female pts >50 y.o were less likely to be admitted to the ICU. ii. Once admitted, women had shorter ICU LOS. iii. Women had higher ICU mortality (HR % CI, )
6 Retrospective study including 98 ICUs (USA, Canada and Brazil) Period: Population: 18,757 patients with the diagnosis of severe sepsis or septic shock
7 After adjustment Female had higher OR for mortality than male 1.11 (95% CI, P=0.002)
8
9
10 Interventions were different on day 1 of ICU. Men received: mechanical ventilation pulmonary artery catheters thrombolytic therapy CABG and emergent surgery
11 Delays matter!
12
13 Delay in ICU admission and Mortality 70.0% 60.0% p= 0.02 (for trend) 50.0% 40.0% Mortality (%) 30.0% 20.0% 43.8% 52.1% 10.0% 29.2% 0.0% < >7.7 MET to consult duration in tertiles (h) Mardini et al. J Critical Care Jun 12
14 Summary & Hypothesis Following ICU admission, data has suggested that female patients have higher mortality compared to male patients. The increased mortality in female patients is not fully understood. Delay in timely access to ICU is associated with poor outcomes. Are delays in critical care access disproportionately affecting woman?
15 Our project To confirm if a mortality difference exists between sexes in our local institutions. To investigate if there are differences between male and female patients, in the time to transfer from wards to the ICU. To determine if there is a difference in mortality according to sex between medical and surgical patients.
16 Our project Retrospective chart review in 2 Academic centres (JGH & MGH) Consecutive medical/surgical patients admitted to the ICU Excluding: CCU Cardiac Surgery Trauma < 48 hrs post-operative < 48 hrs from ER Re-admissions
17 Patient Flow Total Admission 367 Excluded (126) Analysed 241 Medical 144 Surgical 97
18 Results
19 Results Difference in mortality between female and male patients p= Mortality 30d (%) Male Female
20 Results
21 Results Difference in mortality between female and male patients divided in surgical and medical subgroups 60% p= % 53% 40% Male Mortality 30d (%) 30% 20% 26% 32% 34% Female 10% 0% Surgical Medical
22 Results Difference in mortality between female and male patients divided in low vs high APACHE subgroups 60% 50% p= % 40% 42% 43% Mortality 30d (%) 30% 20% 10% 19% Male Female 0% APACHE <= 24 APACHE > 24
23 Causes? Results Increased Delays in females? Concern to consult Time of concern Consult to admission Time of ICU consult Concern to admission Time of ICU admission Patient fulfilled medical Emergency Team (MET) calling criteria, after RN/MD noted a concern
24 Results The increased mortality in female patients does NOT appear to be secondary to increased delay to ICU admission.
25 Results Causes? Increased severity of illness in females? MEWS Score Systolic BP < >200 Heart rate (BPM) < >130 Respirator y rate (RPM) < >30 Temperat ure ( C) < >38.5 AVPU A V P U >5 : OR 5.4 Death (60 D) : OR 10.9 ICU Admission Q J Med 2001; 94:
26 Results The increased mortality in female patients does not appear to be secondary increased severity of illness.
27 Limitations Retrospective study Documentation limitation Accuracy of time estimates in a retrospective study Difference in treatment Small sample size No data following ICU discharge
28 Conclusions Following ICU admission from hospital wards, female patients have higher mortality compared to male patients. The difference in mortality was more pronounced in medical patients. The difference in mortality between sexes was not explained by a difference in baseline characteristics, a delayed admission or a difference in severity of illness. Whether the higher mortality observed in female patients is due to inherent physiologic differences between the sexes or if treatments varied between sexes requires further study.
29 Unanswered Questions o Is there a difference in treatment post ICU admission? o Are female being discharged earlier from the ICU? And Why? o Why is the increased mortality affecting medical patients?
30 Thank you Dr. Jed Lipes Dr. Dev Jayaraman McGill Critical Care CCCF
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