Geschlechtsspezifische Unterschiede bei intensivstationären Patienten und Patientinnen mit Pneumonie in Hinblick auf die Mortalität

Hintergrund: Der Einfluss des Geschlechts auf Infektionen bei intensivstationären Patienten ist weiterhin Grund für kontroverse Diskussionen. Studien liefern sehr heterogene Ergebnisse insbesondere für die Überlebensrate bei Pneumonien. Verschiedene Autoren fanden einen Geschlechtervorteil für Frauen 1,2,3, andere für das männliche Geschlecht 4,5,6,7, wohingegen andere gar keinen Einfluss auf die Mortalität feststellen konnten 8,9. Ziel dieser Studie war es, den geschlechtsspezifischen Einfluss auf die Mortalität bei Patienten zu evaluieren, die mit einer Pneumonie auf der Intensivstation behandelt wurden. Material und Methoden: Aus einer prospektiven observationalen Studie auf 5 anästhesiologisch geführten Intensivstationen wurden Patienten mit der Diagnose einer nosokomialen oder ambulant erworbenen Pneumonie und einer Behandlungsperiode >36 Stunden auf der Intensivstation ausgewertet. Zielgröße der Studie war die intensivstationäre Mortalität. Für die Studie liegen die Voten der Ethikkommission (EA1/127/07) und des Datenschutzbeauftragten vor. Ergebnisse: Insgesamt 436 intensivstationäre Patienten konnten eingeschlossen werden, davon 166 Frauen (38.1%) und 270 Männer (61.9%). Es bestanden bei den Basischarakteristika signifikante Unterschiede beim SOFA-Score bei Aufnahme, der Immunsuppression, den kardiovaskulären Vorerkrankungen und der Inzidenz von Koinfektionen. Bei den männlichen Patienten wurden signifikant mehr gram-negative Erreger detektiert (45.6% vs. 34.9%, p=0.035). Der tägliche Einsatz von Antibiotika war in der Gruppe der Männer häufiger (p=0.028) und auch der summarisch ermittelte Wert der Kosten (in Euro) der applizierten Antiinfektiva lag in dieser Gruppe höher als bei den Frauen (p=0.003). Die Mortalität auf der Intensivstation lag bei 34 (20.5%) für Frauen und 39 (14.4%) bei Männern (p=0.113). Nach Korrektur von Störgrößen mithilfe einer logistischen Regressionsanalyse ergab sich für das weibliche Geschlecht ein erhöhtes Risiko an einer Pneumonie zu versterben mit einer OR von 1.775 (95% Konfidenzintervall 1.029-3.062, p=0.039). Fazit: Das weibliche Geschlecht ist bei intensivstationären Patienten mit Pneumonie mit einer signifikant erhöhten Mortalität assoziiert. Weder vermochten die derzeit genutzten Scoringsysteme wie der SOFA-Score bei Aufnahme dies hinreichend abzubilden, noch sind aktuelle Behandlungsregime auf geschlechtsspezifische Unterschiede hin angepasst. Es scheint, dass die individuelle medizinische Behandlung an das Geschlecht angepasst werden sollte, was über Jahrhunderte hinweg nicht berücksichtigt worden ist.Background: The influence of gender on infections on ICU is still in controversial discussion with studies providing heterogeneous results, especially for pneumonia. Some studies found an advantage for female gender 1,2,3 where as others found some for male gender 4,5,6,7. Others did not find any association of gender with mortality8,9. Aim of this study was to evaluate gender–related differences in mortality of intensive care unit (ICU) patients with pneumonia. Materials and Methods: A prospective observational clinical trial was performed at the university hospital of Berlin. Inclusion criteria were a diagnosis of pneumonia and a treatment period of >36h on ICU. Finally, 436 mainly postoperative patients were included. Data analysis included adherence to guidelines for community or nosocomial pneumonia. Results: 166 females (38.1%) and 270 males (61.9%) were included. There were significant differences in patient characteristics concerning SOFA on admission, immunosuppression, cardiovascular diseases and incidence of co-infections. In male patients significantly more gram-negative pathogens were observed (45.6% vs. 34.9%, p=0.035). Males also received more antibiotic agents per day (p=0,028) and the daily costs (in Euro) for applied anti-infective drugs were significantly higher in the group of male patients compared to the female patients group (p=0.003). Mortality on ICU was 34 (20.5%) in females and 39 (14.4%) in males (p=0.113). After correcting for differences in patient characteristics using logistic regression analysis female gender showed an increased risk for ICU mortality for patients with pneumonia with an OR of 1.775 (1.029-3.062, p=0.039). Conclusion: Female gender is associated with a higher ICU mortality in patients suffering from pneumonia. Neither scoring systems like SOFA score on admission were able to predict this nor are currently used treatment systems adapted to gender differences. It seems that individual medical treatment needs to be adapted to gender, which was not considered while hundreds of years

Female Patients with Pneumonia on Intensive Care Unit Are under Risk of Fatal Outcome

Background and Objectives: The impact of sex on mortality in patients with pneumonia requiring intensive care unit (ICU) treatment is still a controversial discussion, with studies providing heterogeneous results. The reasons for sex differences are widespread, including hormonal, immunologic and therapeutic approaches. This study’s aim was to evaluate sex-related differences in the mortality of ICU patients with pneumonia. Material and Methods: A prospective observational clinical trial was performed at Charité University Hospital in Berlin. Inclusion criteria were a diagnosis of pneumonia and a treatment period of over 24 h on ICU. A total of 436 mainly postoperative patients were included. Results: Out of 436 patients, 166 (38.1%) were female and 270 (61.9%) were male. Significant differences in their SOFA scores on admission, presence of immunosuppression and diagnosed cardiovascular disease were observed. Male patients were administered more types of antibiotics per day (p = 0.028) at significantly higher daily costs (in Euros) per applied anti-infective drug (p = 0.003). Mortalities on ICU were 34 (20.5%) in females and 39 (14.4%) in males (p = 0.113), before correcting for differences in patient characteristics using logistic regression analysis, and afterwards, the female sex showed an increased risk of ICU mortality with an OR of 1.775 (1.029–3.062, p = 0.039). Conclusions: ICU mortality was significantly higher in female patients with pneumonia. The identification of sex-specific differences is important to increase awareness among clinicians and allow resource allocation. The impact of sex on illness severity, sex differences in infectious diseases and the consequences on treatment need to be elucidated in the future

Asymptomatic Plasmodium infection and cognition among primary schoolchildren in a high malaria transmission setting in Uganda.

Asymptomatic parasitemia is common among schoolchildren living in areas of high malaria transmission, yet little is known about its effect on cognitive function in these settings. To investigate associations between asymptomatic parasitemia, anemia, and cognition among primary schoolchildren living in a high malaria transmission setting, we studied 740 children enrolled in a clinical trial in Tororo, Uganda. Parasitemia, measured by thick blood smears, was present in 30% of the children. Infected children had lower test scores for abstract reasoning (adjusted mean difference [AMD] -0.6, 95% confidence interval [CI] -1.01 to -0.21) and sustained attention (AMD -1.6 95% CI -2.40 to -0.81) compared with uninfected children. There was also evidence for a dose-response relationship between parasite density and scores for sustained attention. No associations were observed between anemia and either test of cognition. Schoolchildren in high transmission settings may experience cognitive benefits, from interventions aimed at reducing the prevalence of asymptomatic parasitemia