Markov cohort simulation study reveals evidence for sex based risk difference in intensive care unit patients

BACKGROUND: Despite great advances in intensive care medicine, sepsis still is the leading cause of death. Different strategies have been developed to file the patient data into scoring systems, primarily to predict the outco me. The Markov simulation-predominantly used in economic science to describ e chains of events depending on and influencing each other-seems to be an i nteresting and new approach in analyzing the course of disease of criticall y ill patients in an intensive care unit (ICU). Using such a Markov model, this study analyzes data from 660 surgical ICU patients, 44 of whom died of sepsis. METHODS: A three-state Markov model (integrating sepsis, adult respiratory distress syndrome, and mortality) was constructed to describe the course of disease of critically ill patients in defined cycles and to develop the ri sk profile of different groups of patients. The model enables the compariso n between age- and sex-related survival rates and shows the difference in l ife expectancy compared with an average untreated standard population. RESULTS: Women aged up to 30 years (G1F) show the best prognosis (mortality after 19 cycles 8.3%). On the contrary, the corresponding male group (G1M) demonstrates the worst outcome (mortality after 19 cycles 57.7 %). CONCLUSIONS: The findings of this study fit into the current discussion tha t female patients are better positioned to meet the challenge of sepsis. (C ) 2000 by Excerpta Medica, Inc.