Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age

Carolina Samuelsson, Folke Sjöberg, Göran Karlström, Thomas Nolin, Sten M Walther

Preclinical data indicate that estrogen appears to play a beneficial role in the pathophysiology of and recovery from critical illness. Few previous epidemiologic studies, however, have analysed premenopausal women as a separate group when addressing potential gender differences in critical care outcome. Our aim was to see if premenopausal aged women have a better outcome following critical care and to investigate the association between gender and use of intensive care unit (ICU) resources. Based on 127 254 consecutive Simplified Acute Physiology Score 3 (SAPS 3) -scored Swedish Intensive Care Registry ICU admissions from 2008-2012, we determined the risk-adjusted 30-day mortality, accumulated nurse workload score, and length of ICU stay. To investigate association with gender, we used logistic regression and multivariate analyses on the entire cohort as well as on two subgroups stratified by median age for menopause (up to and including 45 years and >45 years), and six selected diagnostic subgroups (sepsis, multiple trauma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia and cardiac arrest). There was no gender difference in risk-adjusted mortality for the cohort as a whole, and there was no gender difference in risk-adjusted mortality in the group ≤45 years-of-age. For the group of patients > 45 years-of-age we found a reduced risk-adjusted mortality in males admitted for cardiac arrest. For the cohort as a whole, and for those admitted with multiple trauma, male gender was associated with a higher nurse workload score and a longer ICU stay. Using information from a large multiple ICU register database we found that premenopausal female gender was not associated with a survival advantage following intensive care in Sweden. When adjusted for age and severity of illness, male patients use more ICU-resources per admission than female patients.