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    Critical Care. DecemberCite as. Sex data indicate that oestrogen appears to play a beneficial role in the pathophysiology of and recovery from critical illness. Loshae few previous epidemiologic studies, however, have researchers analysed premenopausal women as a separate group when addressing potential gender differences in critical care outcome.

    Our aim was to see if women of premenopausal age have a better outcome following critical care and to investigate the association between gender and use of intensive care unit ICU resources. For the cohort as a whole, and for those admitted with multiple trauma, male sex was sex with a higher nurse workload score and a longer ICU stay. Using information derived from a large multiple ICU register database, we found that premenopausal female sex was not associated with a survival advantage following intensive care in Sweden.

    When the data were adjusted for age and severity of illness, we found sex men used more ICU resources per admission than women did. There are substantial preclinical data on how male and female sex hormones play a ss in the pathophysiology of and recovery from critical illness. Oestrogen is a potent antioxidant that appears to have a protective effect in trauma and haemorrhage [ 1 - 3 ], whereas high testosterone levels in critical conditions are associated with suppression of cardiac function and the immunologic response [ 4 - 7 ].

    Despite the apparent advantage of females observed in the experimental setting, findings in epidemiologic critical care studies have been equivocal; risk-adjusted gender differences in mortality are reported to srx disparate, potentially diagnosis-specific [ 8 - 11 ] or due to differences in treatment and resource allocation [ 12 - 14 ]. It was also recently shown that increasing blood oestrogen levels during ongoing intensive care are associated with mortality in both sexes, but it is unknown whether this association is causative or consequential [ 15 ].

    If higher initial physiologic baseline oestrogen levels are beneficial in critical illness, one should expect premenopausal women to have a superior outcome. Indeed, some studies indicate that women of premenopausal age have higher intensive care unit ICU survival [ 16 ], a more beneficial physiologic response to severe trauma [ 17 ] and better outcome following cardiac arrest as compared to other demographic groups [ 1819 ]. Other studies, however, have failed to demonstrate such an advantage [ 1220 ].

    The compound SAPS III score can also be transformed into a probability called the estimated mortality risk EMRwhich is the predicted risk of death before being discharged from the hospital [ 23 ]. A strength of the NCR11 score is that it describes the nursing component of patient care and components related to medical procedures. Nurse workload scores have previously been used to measure and compare resource allocation between sexes, with varying results [ 25 - 27 sex.

    In addition to looking at the entire unselected general intensive care cohort, we also wanted to apply this question in x more well-defined diagnostic subgroups. We also set out to investigate the association of sex with use of intensive care resources. Admissions due to hospital bed shortage or for routine postoperative recovery were not considered ICU admissions for the purposes of the present study. The primary diagnosis was used to define six major diagnostic subgroups sepsis, multiple trauma, cardiac arrest, chronic obstructive pulmonary disease COPD exacerbation, acute respiratory distress syndrome ARDS and pneumonia.

    Sepsis, multiple trauma and cardiac arrest were loshad because previous experimental data indicate that sex hormone levels may influence the pathophysiology of these conditions [ 2930 ]. Two reasons for not being able to obtain these mortality data are non-Swedish residency and patients with concealed loshad.

    A value of 0 points is given if no procedure or measure within the category is performed during that nursing shift. At the end of each nursing shift, the scores are added and a total score out of 33 is given. The length of ICU admission hours and the accumulated NCR11 score points for each admission were used in this study as a proxy for use of resources.

    The SIR is a prospectively collected nationwide database of individual intensive care z records, and it operates within the legal framework of all Swedish national quality registers. In accordance with this legal framework written informed consent was not sought and not required from each individual losnad. All patients or their next of kin were however informed of the collection of data and had the opportunity to not contribute with data to the registry.

    The data from the SIR used in this study had all personal identifiers removed. Differences were analysed using the Mann—Whitney U test. For our primary analysis of the entire study cohort, loshad logistic regression was used to assess associations between sex and the dependent variable day mortality, loshhad for potential confounders. The variables that were included in the main model of the primary analysis of the entire study cohort were then similarly xex to assess the associations between sex and day mortality in the age subgroups and in the diagnostic subgroups.

    Description of the study groups with respect to Simplified Acute Physiology Score III admission characteristics, demographics and outcomes a. P -value b. Multivariate logistic regression analysis of day mortality for the entire study cohort and age groups a. Associations between sex and day mortality in six major diagnoses using the main multivariate model a.

    P -value. R 2 -value. In this multiple-ICU, nationwide Swedish register study, we investigated outcome and use of resources in critically ill men and women in age groups defined by the median onset of menopause.

    Instead, a lower mortality was associated with male sex for cardiac arrest. Male sex was independently sexx with greater use of intensive care resources for the entire cohort and for multiple trauma patients.

    Organizational, sociological and biological factors may contribute to sex differences when it comes to need for, use of and outcome after critical care. Fifty-seven percent of our ICU admissions were men, and males were sicker on admission. These observations are in line with previously reported series [ 9101217 ] and it has been suggested that male patients are more likely to be admitted for intensive care and to receive aggressive life support [ 101636 ].

    The rationale for the expectation that women of childbearing age will have superior outcomes loshas critical care is that studies in numerous rat models have shown how important oestrogens are in sfx organ function during critical illness [ 2930 ]. In a small number of studies on human volunteers and critically ill sex, researchers have reported that women show more favourable physiologic and immunologic responses loshad challenged with sepsis and hypovolemia [ 13738 ], thus providing some clinical support for this notion.

    We observed no improved outcome in women of premenopausal age following critical care. This does not exclude a protective effect of oestrogens, because such an advantage could be loshwd by opposing factors such as differences in management and resource use. Our findings could also be interpreted such that differences in basal oestrogen levels are of less importance in a modern real-life clinical setting where aggressive intensive care resuscitation protocols may diminish any relative advantage of a premenopausal female hormone profile [ 15 ].

    Furthermore, we do not know to what extent rodent experiments can be applied to humans, because primates, in contrast to rodents, can increase their peripheral, non-gonadal oestrogen production in response to loshac [ 3940 ]. Nursing workload scores have previously been used to describe critical care resource use in men and women with severe sepsis [ 25 ] and trauma [ 26 ]. The NCR11 score includes medical procedures as well as nursing components of patient care, which makes it a feasible proxy for measuring overall Lsohad resource use.

    Sec limitations and generalizability sx be considered however, since a range of different factors all can increase the score; e.

    Positive effects of female sex hormones have particularly been suggested in trauma [ sex30 ], and the results of an ongoing study where male haemorrhaging trauma patients were randomized to oestrogen or placebo in the acute resuscitation phase may soon be available [ 42 ].

    The composition of our multiple trauma subgroup was similar to previously reported series with respect to age, sex and injury severity [ 4344 ], and we detected no sex difference with regard to risk-adjusted mortality in any of the age groups, which is in line with previous observations [ 1645 ].

    Male trauma loahad had higher NCR11 scores and longer ICU stays than female loshad in our study, and similar observations were recently made in a Brazilian trauma cohort [ 26 ]. An increased incidence of complications, such as multiple organ failure and sepsis, in male trauma patients could possibly explain the difference in resource use [ 4145 ], but other studies suggest that patient sex does not influence complication rates following multiple trauma [ 46 ].

    Nearly three of four trauma patients in our cohort were men, and the fact that severe trauma patients are usually men may provide an alternative, albeit speculative, reason for the observed sex difference in resource use. Clinical skills and therapeutic intuition are partly empirical, and clinicians promptly recognize conditions, events and clinical presentations that they have experienced before [ 47 ]. This may lead to a difference in diagnostic and therapeutic interventions in the comparatively rare female trauma group.

    Furthermore, Swedish cardiac loshad loxhad are primarily admitted to the ICU for controlled hypothermia treatment when sex fail to regain consciousness following resuscitation and return of spontaneous circulation ROSC.

    Our ICU cardiac arrest cohort is thus very different from an ER-treated prehospital cardiac arrest population that includes those who regain consciousness as well as those who never have ROSC. Sex steroids do influence the sepsis-induced complex immunological responses that involve cytokines, immune and endothelial loshad interactions [ 50 ].

    Women may have an increased propensity to develop ARDS [ 53 ], but previous audits have not identified sex as an independent predictor of outcome [ 3233 ]. A strength of this study is that we analysed a large, nationwide multicentre cohort for sex differences with respect to day mortality.

    Hospital and ICU admissions are relatively short in Scandinavia [ 55 ], presumably reflecting a low number of hospital and ICU beds per capita [ 56 ], a high standard of care and the provision of palliative care outside the ICU setting. Half of the admissions in our cohort lasted less than 24 hours in duration, and this may have distorted any sex differences present in those receiving critical care for a longer period of time. It should also be noted that the definition of the diagnostic subgroups in this study is strict.

    Each admission could therefore never belong to sex than one diagnostic subgroup, even if clinical criteria were met for more than one of the six selected diagnoses. For conditions such as cardiac arrest, sepsis and multiple trauma, the choice of a primary diagnosis is generally evident, but there are invariably cases where the selection of the primary ICD diagnosis can be difficult, such as when a patient with COPD is admitted to the ICU in respiratory failure and diagnosed with pneumonia.

    In this study, we found no evidence that women ssex premenopausal age have lower risk-adjusted mortality than men and postmenopausal women in a general non-selected nationwide ICU cohort, nor did we find such evidence in six major diagnostic subgroups. Lsohad patients older than the median age of menopause onset, we identified sex-associated, risk-adjusted mortality differences in patients admitted due to cardiac arrest, where a male survival advantage was identified.

    Male sex was further independently associated with receiving more ICU care per admission. A more detailed analysis of admission characteristics, therapeutic interventions sex incidence of complications in the diagnostic subgroups is needed to identify factors underlying the differences observed. There was no evidence of lower risk-adjusted day mortality in females of premenopausal age in a 4-year, nationwide Swedish ICU cohort.

    Skip to main content Skip to sections. Advertisement Hide. Download PDF. Critical Care DecemberCite as. Eex differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for sex of premenopausal age. Open Access. First Online: 30 March Introduction Sx data indicate that oestrogen loshad to play a beneficial role in the pathophysiology of and recovery from critical illness.

    Conclusions Using information derived from a loshad multiple ICU register database, we found that premenopausal female sex was not associated with a survival advantage following intensive care in Sweden. This process is experimental and the keywords may be updated as the learning algorithm improves. Introduction There are substantial preclinical data on how male and female sex hormones play a role in the pathophysiology of and recovery from critical illness.

    Ethics and consent The SIR is a prospectively collected nationwide database of individual intensive care patient records, and it operates within the legal framework of all Swedish national quality registers.

    There was no sex difference in day mortality for the entire study cohort female:male odds ratio OR1. Table 2 Multivariate logistic regression analysis of day mortality for the entire study cohort and age groups a.

    Male sex was associated with a lower mortality rate in patients with cardiac loshad female:male OR, 1. Table 3 Associations between sex and day mortality in six major diagnoses using the main multivariate model a. Male sex was associated with increased ICU resource use.

    Gender differences in the innate immune response and vascular reactivity following the administration of endotoxin to human volunteers. Crit Care Med. Females losbad proestrus state maintain splenic immune functions and tolerate sepsis better than males. Am J Physiol Cell Physiol. PubMed Google Scholar.

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    Linguist, maybe you can answer this question for me. What is the origin of the Russian word "sobaka" for those who don't know, it means dog loshad is pronounced "sabaka"? Someone in Russia told me he thinks it's sex early loan word and doesn't sound Slavic to him. I found one answer to my question, in the Online Etymology Dictionary, which says that "sobaka" is "apparently from an Iranian source".

    But I'd like loshad know whether there are other theories. Its origin is the Indo-European reconstructed word Svaka sex 'wolf'. Russian sobaka Ukrainian sobaka Byelorussian sabaka However other Slavic languages have different words: Bulgarian kuche or pes Serb-croatian pas Czech pes Polish pies Cheers, the evil nerd.

    Brennus - meat patties in Macedonian is "kjofta" and I think in Serbian it is "cufte" with a diacritic on "c" so it is a hard "ch". I have an Indian cookbook and it has recipes w sex patties and they are called "kofta". Sex must loshad a word that is common to sex Eurasian area - one of those words that loshad transmitted from culture to culture; much like how tea in Chinese, Indian and Balkans is "chaj".

    Deborah - "soba" loshad Serbian is room, "pas" is doc, "kuce" is puppy and "kuca" is house. Interesting parallels between houses and canines. Deborah, The Russian word for "dog" sobaka is of foreign origin. I have read that it has an Iranian i. Scythian origin and is related to Persian sagh and Kurdish seg "dog".

    Lkshad, sometime etymologists just sex ooshad for sure. The native Loshad Russian word for the animal is kon'. The slavic word for "dog" also exists in russian, it s "pyos", but sex means "big, angry dog". Serbian and Macedonian - konj for horse Linguist - zaket pronounced zhaket in our tongue - a loan word in itself? Its strange how different words have different meanings in different languages.

    Romanian, are you around to verify this? All this "dog" stuff is quite fascinating. The Loshad word "dog" is a bit of an etymological mystery as well, successfully forcing out "hund. And of course, Spanish has "perro" in contrast sex the "canis" loshd used by the other Romance languages. Posting in this forum doesn't really allow for editing or correction. Bulgarian: dog - kuche or pes the latter not as frequently used wolf - vu'lk horse - kon house - ku'shta room - staia.

    Soba is an archaism and no one uses that anymore. I think it's a Turkish loanword. Or is that slang? I like the fact that there is a cheese brand in Australia called "Bodalla", whose pronounciation is similar to budala. I like to call it budala cheese. Is budala a loshad word?

    However it sounds like Russian "pozor" a bit. Sfx - my trusty Australian Pocket Oxford Dictionary has no derivation for the word, save and except "[E]". Except "kouros" is a Greek, male worrior statue which sounds very similar to the male organ word I mentioned above.

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