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Clinical Trial
, 15 (3), R151

Gender-related Outcome Difference Is Related to Course of Sepsis on Mixed ICUs: A Prospective, Observational Clinical Study

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Clinical Trial

Gender-related Outcome Difference Is Related to Course of Sepsis on Mixed ICUs: A Prospective, Observational Clinical Study

Irit Nachtigall et al. Crit Care.

Abstract

Introduction: Impact 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.

Methods: We 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).

Results: Basic 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.

Conclusions: No 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.

Figures

Figure 1
Figure 1
Flow chart for study enrollment and patient selection.
Figure 2
Figure 2
ICU mortality for main study population and sepsis subgroup.
Figure 3
Figure 3
TISS-28 scoring for severity of disease comparing gender over the first 8 consecutive ICU days. Error bars illustrate the evolution of TISS-28 (Therapeutic Intervention Scoring System-28) scoring for severity of disease comparing gender (m, men; w, women) over the first 8 consecutive ICU days. STD, standard deviation. (a) In the main population, differences between groups were statistically significant for Gender (P < 0.001) and for interaction between Gender and Time (P = 0.029), but not for Time (P = 0.063). (b) In the sepsis subgroup, differences between groups were statistically significant for Gender (P = 0.018) but not for interaction between Gender and Time (P = 0.662) or Time (P = 0.257).

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