Top

Published in:

Open Access 01-04-2013 | Research

The influence of gender on the epidemiology of and outcome from severe sepsis

Authors: Yasser Sakr, Cristina Elia, Luciana Mascia, Bruno Barberis, Silvano Cardellino, Sergio Livigni, Gilberto Fiore, Claudia Filippini, Vito Marco Ranieri

Published in: Critical Care | Issue 2/2013

Abstract

Introduction

The impact of gender on outcome in critically ill patients is unclear. Weinvestigated the influence of gender on the epidemiology of severe sepsis andassociated morbidity and mortality in a large cohort of ICU patients in the regionof Piedmont in Italy.

Methods

This was a post-hoc analysis of data from a prospective, multicenter,observational study in which all patients admitted to one of 24 participatingmedical and/or surgical ICUs between 3 April 2006 and 29 September 2006 wereincluded.

Results

Of the 3,902 patients included in the study, 63.5% were male. Female patients weresignificantly older than male patients (66 ± 16 years vs. 63 ± 16 years,P < 0.001). Female patients were less likely to have severe sepsisand septic shock on admission to the ICU and to develop these syndromes during theICU stay. ICU mortality was similar in men and women in the whole cohort (20.1%vs. 19.8%, P = 0.834), but in patients with severe sepsis wassignificantly greater in women than in men (63.5% vs. 46.4%, P = 0.007).In multivariate logistic regression analysis with ICU outcome as the dependentvariable, female gender was independently associated with a higher risk of ICUdeath in patients with severe sepsis (odds ratio = 2.33, 95% confidence interval =1.23 to 4.39, P = 0.009) but not in the whole cohort (odds ratio = 1.07,95% confidence interval = 0.87 to 1.34).

Conclusion

In this large regional Italian cohort of ICU patients, there were more male thanfemale admissions. The prevalence of severe sepsis was lower in women than in men,but female gender was independently associated with a higher risk of death in theICU for patients with severe sepsis.

Available only for authorised users

Wichmann MW, Inthorn D, Andress HJ, Schildberg FW: Incidence and mortality of severe sepsis in surgical intensive care patients: theinfluence of patient gender on disease process and outcome. Intensive Care Med 2000, 26: 167-172. 10.1007/s001340050041CrossRefPubMed

Rappold JF, Coimbra R, Hoyt DB, Potenza BM, Fortlage D, Holbrook T, Minard G: Female gender does not protect blunt trauma patients from complications andmortality. J Trauma 2002, 53: 436-441. 10.1097/00005373-200209000-00007CrossRefPubMed

Croce MA, Fabian TC, Malhotra AK, Bee TK, Miller PR: Does gender difference influence outcome? J Trauma 2002, 53: 889-894. 10.1097/00005373-200211000-00013CrossRefPubMed

Woods SE, Noble G, Smith JM, Hasselfeld K: The influence of gender in patients undergoing coronary artery bypass graftsurgery: an eight-year prospective hospitalized cohort study. J Am Coll Surg 2003, 196: 428-434. 10.1016/S1072-7515(02)01756-8CrossRefPubMed

Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz PG: Gender-related differences in intensive care: a multiple-center cohort study oftherapeutic interventions and outcome in critically ill patients. Crit Care Med 2003, 31: 1901-1907. 10.1097/01.CCM.0000069347.78151.50CrossRefPubMed

Reinikainen M, Niskanen M, Uusaro A, Ruokonen E: Impact of gender on treatment and outcome of ICU patients. Acta Anaesthesiol Scand 2005, 49: 984-990. 10.1111/j.1399-6576.2005.00759.xCrossRefPubMed

Adrie C, Azoulay E, Francais A, Clec'h C, Darques L, Schwebel C, Nakache D, Jamali S, Goldgran-Toledano D, Garrouste-Org M, Timsit JF: Influence of gender on the outcome of severe sepsis: a reappraisal. Chest 2007, 132: 1786-1793. 10.1378/chest.07-0420CrossRefPubMed

Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, Adhikari NK, Sibbald WJ, Martin CM: Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ 2007, 177: 1513-1519. 10.1503/cmaj.071112PubMedCentralCrossRefPubMed

Magnotti LJ, Fischer PE, Zarzaur BL, Fabian TC, Croce MA: Impact of gender on outcomes after blunt injury: a definitive analysis of morethan 36,000 trauma patients. J Am Coll Surg 2008, 206: 984-991. 10.1016/j.jamcollsurg.2007.12.038CrossRefPubMed

10.

Combes A, Luyt CE, Trouillet JL, Nieszkowska A, Chastre J: Gender impact on the outcomes of critically ill patients with nosocomialinfections. Crit Care Med 2009, 37: 2506-2511. 10.1097/CCM.0b013e3181a569dfCrossRefPubMed

11.

Angstwurm MW, Gaertner R, Schopohl J: Outcome in elderly patients with severe infection is influenced by sex hormonesbut not gender. Crit Care Med 2005, 33: 2786-2793. 10.1097/01.CCM.0000190242.24410.17CrossRefPubMed

12.

Sperry JL, Nathens AB, Frankel HL, Vanek SL, Moore EE, Maier RV, Minei JP: Characterization of the gender dimorphism after injury and hemorrhagic shock: arehormonal differences responsible? Crit Care Med 2008, 36: 1838-1845. 10.1097/CCM.0b013e3181760c14CrossRefPubMed

13.

Diodato MD, Knoferl MW, Schwacha MG, Bland KI, Chaudry IH: Gender differences in the inflammatory response and survival following haemorrhageand subsequent sepsis. Cytokine 2001, 14: 162-169. 10.1006/cyto.2001.0861CrossRefPubMed

14.

Schröder J, Kahlke V, Staubach KH, Zabel P, Stuber F: Gender differences in human sepsis. Arch Surg 1998, 133: 1200-1205. 10.1001/archsurg.133.11.1200CrossRefPubMed

15.

Oberholzer A, Keel M, Zellweger R, Steckholzer U, Trentz O, Ertel W: Incidence of septic complications and multiple organ failure in severely injuredpatients is sex specific. J Trauma 2000, 48: 932-937. 10.1097/00005373-200005000-00019CrossRefPubMed

16.

Laudari L, Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, Fiore G, Filippini C, Ranieri VM: Epidemiology and outcome of sepsis syndromes in Italian ICUs: a regionalmulticenter observational cohort [abstract]. Crit Care 2012,16(Suppl 1):P397.PubMedCentral

17.

Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, Fiore G, Filippini C, Ranieri VM: Being overweight or obese is associated with decreased mortality in critically illpatients: a retrospective analysis of a large regional Italian multicentercohort. J Crit Care 2012, 27: 714-721. 10.1016/j.jcrc.2012.08.013CrossRefPubMed

18.

Le Gall JR, Lemeshow S, Saulnier F: A new Simplified Acute Physiology Score (SAPS II) based on a European/NorthAmerican multicenter study. JAMA 1993, 270: 2957-2963. 10.1001/jama.1993.03510240069035CrossRefPubMed

19.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organdysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems ofthe European Society of Intensive Care Medicine. Intensive Care Med 1996, 22: 707-710. 10.1007/BF01709751CrossRefPubMed

20.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovativetherapies in sepsis. The ACCP/SCCM Consensus Conference Committee. AmericanCollege of Chest Physicians/Society of Critical Care Medicine. Chest 1992, 101: 1644-1655. 10.1378/chest.101.6.1644CrossRefPubMed

21.

Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003, 348: 1546-1554. 10.1056/NEJMoa022139CrossRefPubMed

22.

Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K: International study of the prevalence and outcomes of infection in intensive careunits. JAMA 2009, 302: 2323-2329. 10.1001/jama.2009.1754CrossRefPubMed

23.

Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3ACrossRefPubMed

24.

Jaglal SB, Goel V, Naylor CD: Sex differences in the use of invasive coronary procedures in Ontario. Can J Cardiol 1994, 10: 239-244.PubMed

25.

Schröder J, Kahlke V, Book M, Stuber F: Gender differences in sepsis: genetically determined? Shock 2000, 14: 307-310. 10.1097/00024382-200014030-00011CrossRefPubMed

26.

Knoferl MW, Diodato MD, Angele MK, Ayala A, Cioffi WG, Bland KI, Chaudry IH: Do female sex steroids adversely or beneficially affect the depressed immuneresponses in males after trauma-hemorrhage? Arch Surg 2000, 135: 425-433. 10.1001/archsurg.135.4.425CrossRefPubMed

27.

Knoferl MW, Angele MK, Diodato MD, Schwacha MG, Ayala A, Cioffi WG, Bland KI, Chaudry IH: Female sex hormones regulate macrophage function after trauma-hemorrhage andprevent increased death rate from subsequent sepsis. Ann Surg 2002, 235: 105-112. 10.1097/00000658-200201000-00014PubMedCentralCrossRefPubMed

28.

Adrie C, Alberti C, Chaix-Couturier C, Azoulay E, De Lassence A, Cohen Y, Meshaka P, Cheval C, Thuong M, Troche G, Garrouste-Org M, Timsit JF: Epidemiology and economic evaluation of severe sepsis in France: age, severity,infection site, and place of acquisition (community, hospital, or intensive careunit) as determinants of workload and cost. J Crit Care 2005, 20: 46-58. 10.1016/j.jcrc.2004.10.005CrossRefPubMed

29.

Zellweger R, Wichmann MW, Ayala A, Stein S, DeMaso CM, Chaudry IH: Females in proestrus state maintain splenic immune functions and tolerate sepsisbetter than males. Crit Care Med 1997, 25: 106-110. 10.1097/00003246-199701000-00021CrossRefPubMed

30.

Trentzsch H, Stewart D, De MA: Genetic background conditions the effect of sex steroids on the inflammatoryresponse during endotoxic shock. Crit Care Med 2003, 31: 232-236. 10.1097/00003246-200301000-00036CrossRefPubMed

31.

Eachempati SR, Hydo L, Barie PS: Gender-based differences in outcome in patients with sepsis. Arch Surg 1999, 134: 1342-1347. 10.1001/archsurg.134.12.1342CrossRefPubMed

Title: The influence of gender on the epidemiology of and outcome from severe sepsis
Authors: Yasser Sakr
Cristina Elia
Luciana Mascia
Bruno Barberis
Silvano Cardellino
Sergio Livigni
Gilberto Fiore
Claudia Filippini
Vito Marco Ranieri
Publication date: 01-04-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc12570

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The influence of gender on the epidemiology of and outcome from severe sepsis

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2013

Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials

Palmar skin conductance variability and the relation to stimulation, pain and the motor activity assessment scale in intensive care unit patients

Urinary angiotensinogen predicts adverse outcomes among acute kidney injury patients in the intensive care unit

Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume

Hypercapnia and ventilator-induced diaphragmatic dysfunction

Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study