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

There is a paucity of critical care resources in limited-resource settings. Managing patients with potentially recoverable illnesses and injuries is still inconsistent with evidence-based practices in high-income countries. Given the limited healthcare workforce and practically nonexistent critical care workforce, ICU mortality is high. We sought to evaluate sex differences in ICU and overall hospital mortality in a sub-Saharan African setting. We hypothesized a survival advantage in females.

This is a retrospective analysis of a prospectively collected ICU registry in Malawi. Data variables included baseline demographics, modified early warning score, reason for ICU admission, organ failure, need for ventilator, vasopressors, and ICU outcome (lived or died). Multivariable regression was performed to analyze the relationship between sex and outcome.

This database includes 391 patients, 47.6% male, with a median age of 28 (19-38). 56.0% required vasopressors, 95.9% required a ventilator, and 60.5% experienced low urine output. The median MEWS was 7 (5, 9). Most common reasons for ICU admission included trauma (22.3%) and shock (17.1%). Multivariable logistic regression revealed that female patients had 0.57 (95% CI: 0.35, 0.94) times the odds of ICU death than male patients (p-value = 0.027). There was no statistical difference in hospital mortality based on sex. Overall mortality in the ICU was 50% (194).

ICU mortality in our resource-limited setting is high. After controlling for critical illness severity and other physiologic and critical care variables, there is a survival advantage in favor of females within our ICU setting but not at hospital discharge.