Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis
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...
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| Format: | Article |
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BMJ Publishing Group
2021-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/9/e048982.full |
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| author | Alba Antequera Alfonso Muriel Rosa del Campo Javier Zamora Elena Stallings Gerard Urrútia Ivan Solà Jesus Lopez-Alcalde Manuel Ponce-Alonso Federico Gordo Pilar Fidalgo Ana Verónica Halperin Noelia Álvarez-Díaz Olaya Madrid-Pascual Borja Fernández Félix |
| author_facet | Alba Antequera Alfonso Muriel Rosa del Campo Javier Zamora Elena Stallings Gerard Urrútia Ivan Solà Jesus Lopez-Alcalde Manuel Ponce-Alonso Federico Gordo Pilar Fidalgo Ana Verónica Halperin Noelia Álvarez-Díaz Olaya Madrid-Pascual Borja Fernández Félix |
| author_sort | Alba Antequera |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-50723748b60b4ede86fdf7989baed270 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-50723748b60b4ede86fdf7989baed2702025-08-20T02:18:27ZengBMJ Publishing GroupBMJ Open2044-60552021-09-0111910.1136/bmjopen-2021-048982Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysisAlba Antequera0Alfonso Muriel1Rosa del Campo2Javier Zamora3Elena Stallings4Gerard Urrútia5Ivan Solà6Jesus Lopez-Alcalde7Manuel Ponce-Alonso8Federico Gordo9Pilar Fidalgo10Ana Verónica Halperin11Noelia Álvarez-Díaz12Olaya Madrid-Pascual13Borja Fernández Félix14Institut d’Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain20 Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Carlos III Health Institute, Madrid, SpainDepartment of Microbiology, Hospital Universitario Ramon y Cajal, Madrid, SpainWHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UKClinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, SpainIberoamerican Cochrane Centre, Institut d’Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, SpainClinical Epidemiology and Healthcare Services, Institut d’Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, SpainInstitute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich, Zurich, SwitzerlandDepartment of Microbiology, Hospital Universitario Ramon y Cajal, Madrid, SpainFaculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, SpainFaculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, SpainDepartment of Microbiology, Hospital Universitario Ramon y Cajal, Madrid, SpainMedical Library, Hospital Universitario Ramon y Cajal, Madrid, SpainArztpraxis Kalkbreite, Zurich, SwitzerlandClinical Biostatistics Unit, Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, SpainObjective 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.https://bmjopen.bmj.com/content/11/9/e048982.full |
| spellingShingle | Alba Antequera Alfonso Muriel Rosa del Campo Javier Zamora Elena Stallings Gerard Urrútia Ivan Solà Jesus Lopez-Alcalde Manuel Ponce-Alonso Federico Gordo Pilar Fidalgo Ana Verónica Halperin Noelia Álvarez-Díaz Olaya Madrid-Pascual Borja Fernández Félix Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis BMJ Open |
| title | Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis |
| title_full | Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis |
| title_fullStr | Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis |
| title_full_unstemmed | Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis |
| title_short | Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis |
| title_sort | sex as a prognostic factor for mortality in critically ill adults with sepsis a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/11/9/e048982.full |
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