Association of Sex Differences with Mortality and Organ Dysfunction in Patients with Sepsis and Septic Shock

Abstract

Background: Despite recent advances in the clinical management and understanding of sepsis and septic shock, these complex clinical syndromes continue to have high mortality rates. The effect of sex on these diseases’ mortality, clinical presentation and morbidity remains controversial. This study aimed to investigate the association of sex with mortality and organ dysfunction in patients with sepsis and septic shock. Methods: Prospectively enrolled patients with clinically defined sepsis and septic shock in three intensive care units at University Medical Center Göttingen, Germany, were investigated. The primary outcomes were 28- and 90-day mortality, while the secondary endpoints included the evaluation of organ dysfunction as measured by clinical scores and laboratory parameters. Results: A total of 737 septic patients were enrolled, including 373 in septic shock, 484 males, and 253 females. No significant differences in 28- and 90-day mortality were observed in the cohort. However, men with sepsis had significantly higher SOFA scores, SOFA respiratory and renal subscores, bilirubin and creatinine values, and lower weight-adapted urine outputs, indicating higher organ dysfunction compared to women. Conclusions: Our findings revealed notable differences in organ dysfunction between male and female patients, with males exhibiting more pronounced dysfunction across multiple clinical indicators. These results highlight the potential influence of sex on sepsis disease severity and suggest the need for tailored approaches in sepsis management according to patient sex.

Sex differences in the SOFA score of ICU patients with sepsis or septic shock: a nationwide analysis

“…We found the SOFA components with the most notable sex-specific differences were those based on laboratory values with equal thresholds applied to men and women. Our findings corroborate previous results that found lower SOFA scores in respiratory and renal components in women, as well as lower serum bilirubin and creatinine [ 23 ]. Men in general have a higher muscle mass compared to women of comparable size, resulting in higher levels of creatinine [ 24 , 25 ].…”

“…In our study, we found no differences in ICU mortality between women and men with sepsis or septic shock. This aligns with previous studies [ 23 , 37 ] and a meta-analysis [ 38 ] reporting no significant sex differences in short-term mortality in critically ill patients with sepsis and septic shock. Mewes et al demonstrated in their prospective study enrolling 737 septic patients that men exhibit more severe organ dysfunction according to SOFA and SOFA sub-scores, yet no sex differences were found in 28- and 90-day mortality [ 23 ].…”

“…This aligns with previous studies [ 23 , 37 ] and a meta-analysis [ 38 ] reporting no significant sex differences in short-term mortality in critically ill patients with sepsis and septic shock. Mewes et al demonstrated in their prospective study enrolling 737 septic patients that men exhibit more severe organ dysfunction according to SOFA and SOFA sub-scores, yet no sex differences were found in 28- and 90-day mortality [ 23 ]. Similarly, we found that organ dysfunction and illness severity, as estimated by the SOFA and SAPS II scores, were lower in women but did not translate into better short-term outcomes.…”

Differences in Mortality and Sepsis-Associated Organ Dysfunction between Surgical and Non-Surgical Sepsis Patients

“…Previously described exclusion criteria were applied [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]: Age below 18 years; Pregnancy or breastfeeding; Immunosuppressive drugs and/or chemotherapy within six months prior to enrollment; History of myocardial infarction within six weeks before recruitment; New York Heart Association stage IV chronic heart failure; Human immunodeficiency virus (HIV) infection and/or hepatitis B/C infection; End-stage incurable disease; Persistent vegetative state (apallic syndrome); “Do Not Treat” or “Do Not Resuscitate” order; Participation in interventional studies; Family member of a study-site employee. …”

“…Previously described exclusion criteria were applied [15][16][17][18][19][20][21][22] Eligible patients were categorized according to their recent surgical history into surgical patients (including elective and emergency surgery) and non-surgical patients that did not undergo any type of surgical intervention. Surgical history included cardiac and non-cardiac surgery, including neurosurgery.…”