Abstract
Background. Controversy exists regarding the influence of gender on sepsis events and outcome. Epidemiological data from other countries may not always apply to local circumstances. The aim of this study was to identify gender differences in patient characteristics, treatment, and outcome related to the occurrence of sepsis at admission to the ICU.Methods. A prospective observational cohort study on patients admitted to the ICU over a 3-year period fulfilling sepsis criteria during the first 24 hours. Demographic data, APACHE II score, SOFA score, TISS 76, aetiology, length of stay (LOS), mortality rate, and aspects of treatment were collected and then analysed with respect to gender differences.Results. There were no gender-related differences in mortality or length of stay. Early organ dysfunction assessed as SOFA score at admission was a stronger risk factor for hospital mortality for women than for men. This discrepancy was mainly associated with the coagulation sub-score. CRP levels differed between genders in relation to hospital mortality. Infection from the abdominopelvic region was more common among women, whereas infection from skin or skin structures were more common in men.Conclusion. In this cohort, gender was not associated with increased mortality during a 2-year follow-up period. SOFA score at ICU admission was a stronger risk factor for hospital mortality for women than for men. The discrepancy was mainly related to the coagulation SOFA sub-score. Together with differences in CRP levels this may suggest differences in inflammatory response patterns between genders.
Highlights
A common observation in epidemiological studies of sepsis/severe sepsis is that men account for approximately 60% of patients, but the impact of gender on outcome is less clear [1,2,3,4,5]
A French study showed that the overall hospital mortality from severe sepsis was lower in women and that this discrepancy was due to lower mortality in post-menopausal women [10]
There are reports of higher case fatality rates among women suffering from sepsis [14], of female gender being an independent predictor of increased mortality in patients with documented infection [4], and studies of mainly surgical patients report a poorer outcome from severe sepsis for women [15,16]
Summary
A common observation in epidemiological studies of sepsis/severe sepsis is that men account for approximately 60% of patients, but the impact of gender on outcome is less clear [1,2,3,4,5]. Other studies have reported a higher incidence of sepsis in men but no gender-related differences in mortality [11,12,13]. The aim of this study was to identify gender differences in patient characteristics, treatment, and outcome related to the occurrence of sepsis at admission to the ICU. Organ dysfunction assessed as SOFA score at admission was a stronger risk factor for hospital mortality for women than for men. This discrepancy was mainly associated with the coagulation sub-score. SOFA score at ICU admission was a stronger risk factor for hospital mortality for women than for men. Gender Age (years) Admission type medical APACHE II SOFA_0 SOFA_1a SOFA_max Haematological disease Chronic corticosteroid medication Septic shock C-reactive proteina (0.75–3.88) (1.01–1.08) (1.13–7.90) (1.05–1.20) (1.09–1.36) (0.92–1.10) (1.13–1.41) (2.07–25.42) (2.11–54.62)
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