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SEX-BASED DIFFERENCES IN ADULTS WITH COMMUNITY-ACQUIRED BACTERIAL…
SEX-BASED DIFFERENCES IN ADULTS WITH COMMUNITY-ACQUIRED BACTERIAL MENINGITIS: A PROSPECTIVE COHORT STUDY
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METHODS
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Statistical analysis
Continuous variables are expressed as median (interquartile range [IQR]), and were compared using the MannWhitney U test; the Chi-Square test or Fisher exact test, as appropriate, were used to study categorical variables.
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Two tailed,
significance set at 0.05
For univariable testing> significant by dividing 0.05 by the number of comparisons (61) so alpha equals 0.0008
Odds ratios (OR) and 95% confidence intervals (CI) were used to quantify the strength of associations.
logistic regression analysis to examine the association between sex, severity of illness and the likelihood of unfavourable outcome.
Confounding= statistically significant association+ unfavourable outcome. Interaction of variables in the association of patient sex and outcome was evaluated by interaction terms. The linear relationship between continuous predictors and unfavourable outcome was evaluated by the Hosmer-Lemeshow goodness of fit test and inspection of locally weighted scatterplot smoothing curves. In case of a clearly nonlinear relationship, continuous variables were categorized using normal ranges when possible to facilitate interpretation. We estimated both univariable crude OR and multivariable OR corrected for all variables in the model. All co-variables were entered simultaneously in the logistic regression model. Multiple imputation was performed for missing data in the multivariable analysis using all predictors together. Final estimates were obtained by pooling the coefficients of 60 rounds of imputation. All statistical tests were two-tailedAnalyses were performed using IBM SPSS Statistics (version 22.0), and imputation was done using the Mice package (version 2.25) in R version 3.2.3 #
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From January 2006 to July 2014, adults with community-acquired bacterial meningitis were prospectively evaluated in a nationwide cohort study in the Netherlands.
Results
evaluated 1412 episodes of meningitis, 707 (50%) in males
W>M
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Despite similar rates of cardiorespiratory failure, women were less likely to receive mechanical ventilation , un
The proportion of unfavourable outcome was lower in patients treated with adjunctive dexamethasone, un
Based on the Dutch Meningitis Risk Score, illness severity at presentation was higher . Nevertheless, they were less likely to be admitted or transferred to an intensive care unit (
M>W
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Seizures and focal neurological deficits, un
caused by Listeria monocytogenes , un
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Systemic complications, sig
Higher rate of death and unfavorable outcome, un
The association remained significant after further correcting for S. pneumoniae as causative pathogen and adjunctive treatment with dexamethasone (OR for unfavourable outcome 1.32, 95% CI 1.01–1.72, p=0.04; and OR for death 1.45, 95% CI 1.02–2.05, p=0.04).
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Conclusion
Male sex is an independent risk factor for adverse outcome. It is possible that sex-based differences in immune reaction could determine a distinct response to corticosteroids.
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