Sex Dimorphism in Intensive Care Unit Mortality at a Resource-Limited Setting

Area of Science:

• Critical Care Medicine
• Global Health
• Sex Differences in Health Outcomes

Background:

• Limited critical care resources in low-income countries lead to inconsistent evidence-based practices.
• High intensive care unit (ICU) mortality is prevalent due to workforce shortages.
• Sub-Saharan Africa faces significant challenges in critical care provision.

Purpose of the Study:

• To investigate sex-based differences in ICU and overall hospital mortality.
• To evaluate if females have a survival advantage in a Malawian ICU setting.
• To identify factors influencing mortality in a resource-limited critical care environment.

Main Methods:

• Retrospective analysis of a prospectively collected ICU registry in Malawi.
• Inclusion of demographic data, modified early warning score (MEWS), admission reasons, organ failure, and interventions (ventilators, vasopressors).
• Multivariable logistic regression to assess the association between sex and ICU mortality.

Main Results:

• The study included 391 patients, with 47.6% males and a median age of 28.
• High rates of critical illness were observed: 95.9% required ventilation, 56.0% needed vasopressors.
• Female patients demonstrated a statistically significant survival advantage, with 0.57 times the odds of ICU death compared to males (p=0.027).

Conclusions:

• ICU mortality remains high in this resource-limited setting.
• Females exhibit a survival advantage within the ICU after adjusting for illness severity.
• No significant sex difference in overall hospital mortality was detected.