Sex matters: Is it time for a SOFA makeover?

by Emma Larsson 

Critical Care 28, Article number: 268 (2024) Published 8 August 2024

While sepsis affects individuals regardless of sex, emerging research has highlighted notable differences in how women and men experience, respond to, and recover from sepsis treated in intensive care units (ICU). These differences are influenced by a complex interplay of biological, hormonal, and sociocultural factors. As we explore sepsis management in ICU settings, it becomes evident that understanding the factors contributing to these sex-based variations is important for tailoring therapeutic approaches and improving overall patient outcomes. Moreover, for a nuanced interpretation of current evidence, it is worth noting the distinction between the terms gender and sex: gender refers to the socially constructed roles and behaviors that a given society considers appropriate, while sex pertains to biological characteristics...

 

Influence of gender on age-associated in-hospital mortality in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study

by Ryoung-Eun Ko, Danbee Kang, Juhee Cho, Soo Jin Na, Chi Ryang Chung, Sung Yoon Lim, Yeon Joo Lee, Sunghoon Park, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Haein Lee, Chae-Man Lim and Gee Young Suh 

Critical Care volume 27, Article number: 229 Published: 11 June 2023

 

Background

Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have shown conflicting evidence. This study aimed to investigate the effect of gender on in-hospital mortality due to sepsis according to age group.

Methods

This study used data from the Korean Sepsis Alliance, an ongoing nationwide prospective multicenter cohort from 19 participating hospitals in South Korea. All adult patients diagnosed with sepsis in the emergency departments of the participating hospitals between September 2019 and December 2021 were included in the analysis. Clinical characteristics and outcomes were compared between male and female. Eligible patients were stratified by age into 19–50 years, 50–80 years, and ≥ 80 years old individuals.

Results

During the study period, 6442 patients were included in the analysis, and 3650 (56.7%) were male. The adjusted odds ratio (OR) [95% confidence interval (CI)] for in-hospital mortality for male compared with female was 1.15 (95% CI = 1.02–1.29). Interestingly, in the age 19–50 group, the risk of in-hospital mortality for males was significantly lower than that of females [0.57 (95% CI = 0.35–0.93)]. For female, the risk of death remained relatively stable until around age 80 (P for linearity = 0.77), while in males, there was a linear increase in the risk of in-hospital death until around age 80 (P for linearity < 0.01). Respiratory infection (53.8% vs. 37.4%, p < 0.01) was more common in male, whereas urinary tract infection (14.7% vs. 29.8%, p < 0.01) was more common in female. For respiratory infection, male had significantly lower in-hospital mortality than female in the age 19–50 groups (adjusted OR = 0.29, 95% CI = 0.12–0.69).

Conclusions

Gender may influence age-associated sepsis outcomes. Further studies are needed to replicate our findings and fully understand the interaction of gender and age on the outcomes of patients with sepsis.

 

 

 

 

 

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

 

by Modra, Lucy J.; Higgins, Alisa M.; Abeygunawardana, Vihangi S.; Vithanage, Ruvini N.; Bailey, Michael J.; Bellomo, Rinaldo 

 

Critical Care Medicine: June 2022 - Volume 50 - Issue 6 - p 913-923

 

OBJECTIVES: 

To evaluate and synthesize the available literature on sex differences in the treatment of adult ICU patients.

DATA SOURCES: 

MEDLINE and EMBASE.

STUDY SELECTION: 

Two reviewers independently screened publications to identify observational studies of adult ICU patients that explicitly examined the association between sex and ICU treatment—specifically, mechanical ventilation, renal replacement therapy, and length of stay.

DATA EXTRACTION: 

We extracted data independently and in duplicate: mean age, illness severity, use of mechanical ventilation and renal replacement therapy, and length of stay in ICU and hospital. We assessed risk of bias using the Newcastle-Ottawa Scale. We used a DerSimonian-Laird random-effects model to calculate pooled odds ratios (ORs) and mean differences between women and men.

DATA SYNTHESIS: 

We screened 4,098 publications, identifying 21 eligible studies with 545,538 participants (42.7% women). The study populations ranged from 246 to 261,255 participants (median 4,420). Most studies (76.2%) were at high risk of bias in at least one domain, most commonly representativeness or comparability. Women were less likely than men to receive invasive mechanical ventilation (OR, 0.83; 95% CI, 0.77–0.89; I2 = 90.4%) or renal replacement therapy (OR, 0.79; 95% CI, 0.70–0.90; I2 = 76.2%). ICU length of stay was shorter in women than men (mean difference, –0.24 d; 95% CI, –0.37 to –0.12; I2 = 89.9%). These findings persisted in meta-analysis of data adjusted for illness severity and other confounders and also in sensitivity analysis excluding studies at high risk of bias. There was no significant sex difference in duration of mechanical ventilation or hospital length of stay.

CONCLUSIONS: 

Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses.

 

Gender related outcome difference is related to course of sepsis on mixed ICUs

Gender related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study. Critical Care 2011, 15:R151

Natchtigall I., et al.

http://ccforum.com/content/15/3/R151

Impact of gender on severe infections is in highly controversial discussion with natural survival advantage of females described in animal studies but contradictory to human data. This study aims to describe impact of gender on outcome in mixed intensive care units (ICU) with a special focus on sepsis. Conclusions: There were no differences in patients' outcome related to gender aspects on mainly surgical ICUs. However, for patients suffering from sepsis there is an increase of mortality related to the female sex.