Gender-related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study

Abstract

IntroductionImpact of gender on severe infections is in highly controversial discussion with natural survival advantage of females described in animal studies but contradictory to those described human data. This study aims to describe the impact of gender on outcome in mixed intensive care units (ICUs) with a special focus on sepsis.MethodsWe performed a prospective, observational, clinical trial at Charité University Hospital in Berlin, Germany. Over a period of 180 days, patients were screened, undergoing care in three mainly surgical ICUs. In total, 709 adults were included in the analysis, comprising the main population ([female] n = 309, [male] n = 400) including 327 as the sepsis subgroup ([female] n = 130, [male] n = 197).ResultsBasic characteristics differed between genders in terms of age, lifestyle factors, comorbidities, and SOFA-score (Sequential Organ Failure Assessment). Quality and quantity of antibiotic therapy in means of antibiotic-free days, daily antibiotic use, daily costs of antibiotics, time to antibiotics, and guideline adherence did not differ between genders. ICU mortality was comparable in the main population ([female] 10.7% versus [male] 9.0%; P = 0.523), but differed significantly in sepsis patients with [female] 23.1% versus [male] 13.7% (P = 0.037). This was confirmed in multivariate regression analysis with OR = 1.966 (95% CI, 1.045 to 3.701; P = 0.036) for females compared with males.ConclusionsNo differences in patients' outcome were noted related to gender aspects in mainly surgical ICUs. However, for patients with sepsis, an increase of mortality is related to the female sex.

Sex and Mortality of Hospitalized Adults After Admission to an Intensive Care Unit

“…to evaluate the reliability of time assessments for delay from meeting the MET criterion to time of ICU admission; the Lin correlation coefficient was 0.94. Modified early warning scores (MEWS) were calculated for the time E vidence [1][2][3] indicates that women have a higher mortality after admission to an intensive care unit (ICU) than do men. The reasons for this difference are poorly understood, and many questions remain unanswered.…”

“…We did not analyze the treatments our patients received before and during their ICU admission, and we therefore cannot determine if women were treated less aggressively or less appropriately than were men. Larger studies 1,2 have shown that compared with men, women are treated more conservatively (ie, fewer invasive procedures, fewer intubations, more code status limitations). However, in our cohort of patients, MEWS before ICU admission, APACHE II scores at the time of ICU admission, and code status limitations did not differ between men and women.…”

One Year Survival and Quality of Life in Patients Successfully Discharged From Neuro Critical Care Unit

“…Other reports have shown sex differentiation outcome is based on etiology; for example, one study reported no differences between sex outcomes in surgical ICUs, although sepsis increased the death rate in females [12,13]. According to above studies, the reasons for higher mortality in women during critical states, despite protective role of estrogen on cardiovascular and immune systems, have been poorly studied.…”

Sex Hormones and Bacterial Infections

“…In contrast to susceptibility to bacterial infections, studying the role of sex in the mortality provided contrasting evidence. Some epidemiological studies did not report any gender differences in sepsis-related death (Crabtree et al, 1999;Martin et al, 2003;Laupland et al, 2004;Esper et al, 2006) whereas other found either increased mortality in men (Osborn et al, 2004;Melamed & Sorvillo, 2009;Wafaisade et al, 2011) or women (Combes et al, 2009;Pietropaoli et al, 2010;Nachtigall et al, 2011). As men are also at increased risk of death due to trauma, cancer and cardiovascular diseases as compared with women, the analysis of epidemiological data should integrate these potential biases (Micheli et al, 2009;Pinkhasov et al, 2010;Coronado et al, 2011).…”