Impact of Sex Differences on Mortality in Patients With Sepsis After Trauma: A Nationwide Cohort Study

Abstract

ObjectiveSepsis is the leading cause of death in intensive care units, and sepsis after trauma is associated with increased mortality rates. However, the characteristics of sepsis after trauma remain unknown, and the influence of sex on mortality remains controversial. This study aimed to assess the role of sex in in-hospital mortality in patients with sepsis after trauma.MethodsWe performed a retrospective cohort study involving several emergency hospitals (n=288) in Japan. The data of patients with trauma who developed sepsis after admission from 2004 to 2019 were obtained from the Japan Trauma Data Bank. We divided the patients into two groups according to sex and compared their in-hospital mortality. We also performed subgroup analysis limited to the elderly population (age ≥ 65 years) and evaluated in-hospital mortality between men and women.ResultsA total of 1935 patients met the inclusion criteria during the study period. Of these, 1204 (62.2%) were allocated to the male group and 731 (37.8%) to the female group. Multivariable Cox proportional-hazards analysis showed a significantly lower risk of in-hospital mortality in the female group than in the male group (hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.62–0.89; p=0.001). In the subgroup analysis, multivariable Cox proportional hazards still showed significantly lower risks of in-hospital mortality in the female group than in the male group (HR: 0.72, 95% CI: 0.58–0.88; p=0.002).ConclusionThe present study shows a significantly increased survival in the female group when compared to that in the male group of patients with sepsis after trauma. The underlying mechanism remains unclear, and further investigations are required.

The neutrophil-to-lymphocyte ratio: A potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury

“…Sex also has an impact on the prognosis of trauma patients; the risk of in-hospital death in men is 2.08 times higher than that in females. Many studies have confirmed that acknowledging possible gender differences in a wider range of trauma symptoms may have clinical benefits (17,18). It is very important to select an easily detected and available laboratory index to further predict the prognosis of patients or improve the accuracy of prognosis prediction.…”

IGF‐1 regulates astrocytic phagocytosis and inflammation through the p110α isoform of PI3K in a sex‐specific manner

“…Sexual dimorphism in response to bacterial infections has been extensively described in hospital environments, where it has been observed that men were more susceptible to bacteremia than women (Bösch et al, 2018 ; McGowan Jr. et al, 1975 ) and mortality was less common in women after a septic infection than men (Kondo et al, 2021 ). In the context of central nervous system (CNS), numerous neurological and psychiatric disorders show sex differences in incidence, age of onset, symptomatology or outcome and most of these disorders course with neuroinflammation (Giatti et al, 2020 ).…”

A Nomogram to Better Predict the In-Hospital Mortality of Trauma Patients with Sepsis in the Intensive Care Unit

“…A predictive score has been developed to predict sepsis risk among trauma patients [ 10 ]. A nationwide cohort study reported a relationship between sex differences and mortality in patients with sepsis after trauma [ 11 ]. In summary, recent research has predominantly focused on the risk factors for post-traumatic sepsis, and few studies have examined risk factors associated with the in-hospital mortality of trauma patients with sepsis.…”