Article Text
PDF
Abstract
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.
- epidemiology
- adult intensive & critical care
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information. The study protocol is available online at http://dx.doi.org/10.1136/bmjopen-2019-035927 and PROSPERO CRD42019145054. Included studies are publicly available, main data supporting the conclusions of this systematic review are included in the article and supplemental material.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information. The study protocol is available online at http://dx.doi.org/10.1136/bmjopen-2019-035927 and PROSPERO CRD42019145054. Included studies are publicly available, main data supporting the conclusions of this systematic review are included in the article and supplemental material.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Twitter @JLopezAlcalde
Contributors JL-A, JZ and AA conceived the systematic review. AA coordinated the systematic review. AA, JL-A, ES, JZ, and IS designed the systematic review. JL-A, NÁ-D, AA, and IS designed the search strategy. AA, ES, BFF, AVH, MP-A, PF, RdC, OM-P, AM, JZ and JL-A screened abstracts and full texts. AA, ES and OM-P extracted data and assessed. AA, JL-A, ES, AM and BFF elaborated the analysis plan. AA performed the statistical analyses. JL-A and AA conducted the GRADE assessment. AA, AVH, FG, PF, MP-A, RdC and OM-P provided clinical perspective. JL-A, AA, AM, IS, JZ, ES and GU provided methodological perspective. AA drafted the first version of the manuscript. All authors had the opportunity to read approved the final manuscript. JZ, JL-A and GU secured funding for the systematic review. AA is the guarantor. AA is a doctoral candidate in Methodology of Biomedical Research and Public Health, at the Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine at Universitat Autònoma de Barcelona (Spain) and this work is part of her PhD.
Funding The SEXCOMPLEX project was supported by Instituto de Salud Carlos III (Plan Estatal de I+D + i 2013–2016) and cofinanced by the European Development Regional Fund 'A way to achieve Europe' (ERDF) grant number PIE16/00050. AA was funded by the Instituto de Salud Carlos III through the 'Acción Estratégica en Salud 2013–2016/Contratos Río Hortega call 2018/ CM18/00141' (Co-funded by European Social Fund 2014–2020, 'Investing in your future'). MP-A is also the recipient of a Río Hortega Contract (CM19/00069). CIBERESP funded BF-F.
Disclaimer These funding sources had no role in the design of this review, its execution, analyses, interpretation of the data, or decision to submit results.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.