The influence of gender on the epidemiology of and outcome from severe sepsis.

INTRODUCTION: The impact of gender on outcome in critically ill patients is unclear. We investigated the influence of gender on the epidemiology of severe sepsis and associated morbidity and mortality in a large cohort of ICU patients in the region of Piedmont in Italy. METHODS: This was a post-hoc analysis of data from a prospective, multicenter, observational study in which all patients admitted to one of 24 participating medical and/or surgical ICUs between 3 April 2006 and 29 September 2006 were included. RESULTS: Of the 3,902 patients included in the study, 63.5% were male. Female patients were significantly older than male patients (66±16 years vs. 63±16 years, P<0.001). Female patients were less likely to have severe sepsis and septic shock on admission to the ICU and to develop these syndromes during the ICU stay. ICU mortality was similar in men and women in the whole cohort (20.1% vs. 19.8%, P=0.834), but in patients with severe sepsis was significantly greater in women than in men (63.5% vs. 46.4%, P=0.007). In multivariate logistic regression analysis with ICU outcome as the dependent variable, female gender was independently associated with a higher risk of ICU death in patients with severe sepsis (odds ratio=2.33, 95% confidence interval=1.23 to 4.39, P=0.009) but not in the whole cohort (odds ratio=1.07, 95% confidence interval=0.87 to 1.34). CONCLUSION: In this large regional Italian cohort of ICU patients, there were more male than female admissions. The prevalence of severe sepsis was lower in women than in men, but female gender was independently associated with a higher risk of death in the ICU for patients with severe sepsis.

The impact of age on outcome after major surgical procedures.

PURPOSE: The aim of this study was to investigate the effects of age on outcome in a large cohort of surgical intensive care unit (ICU) patients. METHODS: In this retrospective analysis of prospectively collected data, all 11537 adult patients admitted directly from the operating room to our 50-bed surgical ICU between January 1, 2004, and January 31, 2009, were included. Patients were classified into 5 subgroups according to age (18-50 [reference category], 51-65, 66-75, 76-85, >85 years). RESULTS: Severity scores and the incidence of comorbid conditions on ICU admission increased steadily with age. Intensive care unit and hospital mortality rates were 4.4% and 8.7%, respectively, and increased with age to reach 12.4% and 28.2%, respectively, in patients older than 85 years. In multivariate logistic regression analysis, age was an independent risk factor for in-hospital death (odds ratio, 1.04; 95% confidence interval, 1.03-1.04, per year; P < .001). Gastrointestinal surgery was independently associated with a higher risk of in-hospital mortality in patients older than 50 years, whereas neurosurgery was associated with a higher risk of in-hospital death only in patients older than 65 years. CONCLUSIONS: Mortality rates increase with age, with an exponential increase in patients older than 65 years. Age is an independent risk factor for in-hospital death, irrespective of the type of surgical intervention.

Being overweight or obese is associated with decreased mortality in critically ill patients: a retrospective analysis of a large regional Italian multicenter cohort.

PURPOSE: To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes. METHODS: All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective, multicenter study. RESULTS: Mean body mass index (BMI) was 26.0 ± 5.4 kg/m(2): 32.8% of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery. CONCLUSIONS: In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients.

Quantitative ultrasound at the phalanges in monitoring alendronate therapy.

This study evaluated the efficacy of quantitative ultrasound (QUS) at the phalanges in monitoring alendronate treatment. Seventy-nine postmenopausal women were enrolled: 46 subjects entered therapy with alendronate, the remaining 33 did not follow any therapeutic regimen. All subjects underwent phalangeal ultrasound measurement before starting treatment and after 12 mo. Two QUS parameters were measured: AD-SoS (Amplitude Dependent Speed of Sound) in m/s, and BTT (Bone Transmission Time) in micros. Mean age of subjects at the beginning of the study was 58.7 +/- 6.5 y, mean BMI was 26.6 +/- 4.4 kg/m(2), mean time since menopause was 6.7 +/- 5.0 y; no significant differences could be observed between the groups (p > 0.05). At 12-mo follow-up a significant increase of both QUS parameters was observed: +18.8 +/- 24.4 m/s for AD-SoS, p < 0.0001; +0.05 +/- 0.08 micros for BTT, p < 0.001. In the nontreated group AD-SoS was stable (+1.0 +/- 33.7 m/s), as well as BTT (-0.07 +/- 0.25 micros), p = n.s. for both. In the treated group the percentage of responders was 65.2% for AD-SoS and 50.0% for BTT. The percentage of non responders was 13% for AD-SoS and 15.2% for BTT. The results confirm that the effect of alendronate treatment may be suggested by QUS at the phalanges after 12 mo of treatment.