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Meta-Analysis
. 2022 Jun 1;50(6):913-923.
doi: 10.1097/CCM.0000000000005469. Epub 2022 Feb 14.

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Lucy J Modra  1   2 , Alisa M Higgins  3 , Vihangi S Abeygunawardana  2 , Ruvini N Vithanage  4 , Michael J Bailey  3 , Rinaldo Bellomo  1   2   3   5
Affiliations
Meta-Analysis

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Lucy J Modra et al. Crit Care Med. .

Abstract

Objectives: To evaluate and synthesize the available literature on sex differences in the treatment of adult ICU patients.

Data sources: MEDLINE and EMBASE.

Study selection: Two reviewers independently screened publications to identify observational studies of adult ICU patients that explicitly examined the association between sex and ICU treatment-specifically, mechanical ventilation, renal replacement therapy, and length of stay.

Data extraction: We extracted data independently and in duplicate: mean age, illness severity, use of mechanical ventilation and renal replacement therapy, and length of stay in ICU and hospital. We assessed risk of bias using the Newcastle-Ottawa Scale. We used a DerSimonian-Laird random-effects model to calculate pooled odds ratios (ORs) and mean differences between women and men.

Data synthesis: We screened 4,098 publications, identifying 21 eligible studies with 545,538 participants (42.7% women). The study populations ranged from 246 to 261,255 participants (median 4,420). Most studies (76.2%) were at high risk of bias in at least one domain, most commonly representativeness or comparability. Women were less likely than men to receive invasive mechanical ventilation (OR, 0.83; 95% CI, 0.77-0.89; I2 = 90.4%) or renal replacement therapy (OR, 0.79; 95% CI, 0.70-0.90; I2 = 76.2%). ICU length of stay was shorter in women than men (mean difference, -0.24 d; 95% CI, -0.37 to -0.12; I2 = 89.9%). These findings persisted in meta-analysis of data adjusted for illness severity and other confounders and also in sensitivity analysis excluding studies at high risk of bias. There was no significant sex difference in duration of mechanical ventilation or hospital length of stay.

Conclusions: Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses.

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Conflict of interest statement

Drs. Modra and Vithanage disclosed that they are members of the Women in Intensive Care Network, Australia and New Zealand Intensive Care Society. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Dataset use reported in

References

    1. Mahmood K, Eldeirawi K, Wahidi MM: Association of gender with outcomes in critically ill patients. Crit Care 2012; 16:R92
    1. Raine R, Goldfrad C, Rowan K, et al.: Influence of patient gender on admission to intensive care. J Epidemiol Community Health 2002; 56:418–423
    1. Shen HN, Lu CL, Yang HH: Women receive more trials of noninvasive ventilation for acute respiratory failure than men: A nationwide population-based study. Crit Care 2011; 15:R174
    1. Garland A, Olafson K, Ramsey CD, et al.: Reassessing access to intensive care using an estimate of the population incidence of critical illness. Crit Care 2018; 22:208
    1. Modra LJ, Pilcher D, Bailey M, et al.: Sex differences in intensive care unit admisisons in Australia and New Zealand. Crit Care Resus 2021; 23:86–93

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