Gender-differences in outcomes of patients in Intensive Care Unit: findings from the SPINUTI network

Abstract

Abstract Background Achieving gender equality is one of the most important Sustainable Development Goals to guarantee health and wellbeing worldwide. Here, we aimed to assess gender-differences in risk factors and outcomes among patients admitted to Italian Intensive Care Units (ICUs). Methods Here, we included 12,534 patients from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 48 hours. Firstly, characteristics at ICU admission were compared between males and females using the Mann-Whitney U or the Chi-Squared tests. Next, we compared the probability of death between genders by applying a logistic regression analysis. Results were adjusted for covariates (i.e., age, patient's origin, trauma, non-surgical treatment for acute coronary disease, surgical intervention and presence of intubation) and reported as Odds ratio (OR) and 95% Confidence Interval (CI). Finally, the Kaplan-Meier analysis was applied to assess gender difference in survival. Results Compared with male patients, females were older, more likely to come from other wards or healthcare facilities and to undergo a surgical intervention (p-values<0.05). By contrast, they were less likely to be intubated or traumatized and to undergo non-surgical treatment for acute coronary disease (p-values<0.05). Interestingly, a higher proportion of deaths was reported in female patients (p < 0.001), so that their odds of dying was 13% higher than males (OR = 1.13; 95%CI=1.00-1.28; p = 0.046) after adjusting for covariates. Accordingly, females reported lower survival in ICU than males (median= 32.0 days vs. median= 34.0 days; p < 0.001). Conclusions Our results pointed out gender-differences in patients' characteristics at ICU admission, which resulted into a higher risk of death and lower survival among females. In a Public Health point of view, these findings underline that is still important to sustain gender equality in ICUs and other hospital wards. Key messages There are several gender-differences in risk factors and outcomes among patients admitted to ICUs. Gender poses per se a higher risk for death in ICU, also considering other risk factors.