Women have more severe disease, greater mortality than men in ICU

Women admitted to the intensive care unit (ICU) suffer worse illness severity and higher ICU mortality risks than men, reports a recent meta-analysis.

Drawing from the online databases of Medline and Embase, the researchers retrieved 21 eligible studies, corresponding to 505,138 adult ICU patients (43.1 percent women). Only two studies were deemed to have low risks of bias across all domains; the remaining studies had problems in terms of representativeness and unclear reporting of methods and results. The funnel plot for adjusted mortality was asymmetrical, suggesting possible publication or nonreporting bias.

Pooled analysis of 17 studies (n=482,652) showed that women tended to have higher illness severity scores than men at ICU admission (standardized mean difference [SMD], 0.04, 95 percent confidence interval [CI], –0.01 to 0.09; p=0.13).

These studies used different tools to quantify disease severity, each of which was treated as a subgroup within the overall meta-analysis but resulted in high overall heterogeneity of evidence.

Twenty studies (n=501,297) looked at sex differences in unadjusted mortality, while 12 (n=477,826) examined adjusted mortality. Women had nearly 10-percent greater risk of unadjusted mortality at ICU discharge than men, though such a difference was only of borderline significance (odds ratio [OR], 1.09, 95 percent CI, 1.00–1.18).

In adjusted analysis, between-sex difference reached statistical significance in terms of mortality at ICU discharge (OR, 1.25, 95 percent CI, 1.03–1.50) and at 1 year and beyond (OR, 1.08, 95 percent CI, 1.02–1.13). No such effect was reported at other timepoints.