Association of Gender With Outcome and Host Response in Critically Ill Sepsis Patients*. Issue 11 (November 2017)

• Record Type: Journal Article
• Authors: van Vught, Lonneke A.; Scicluna, Brendon P.; Wiewel, Maryse A.; Hoogendijk, Arie J.; Klein Klouwenberg, Peter M. C.; Ong, David S. Y.; Cremer, Olaf L.; Horn, Janneke; Franitza, Marek; Toliat, Mohammad R.; Nürnberg, Peter; Bonten, Marc M. J.; Schultz, Marcus J.; van der Poll, Tom
• Is Part Of: Critical care medicine. Volume 45:Issue 11(2017)
• Publication Date: 2017-11
• Subjects: immune response -- infection -- intensive care unit -- organ failure -- sex; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002649
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objective: To determine the association of gender with the presentation, outcome, and host response in critically ill patients with sepsis. Design and Setting: A prospective observational cohort study in the ICU of two tertiary hospitals between January 2011 and January 2014. Patients: All consecutive critically ill patients admitted with sepsis, involving 1, 815 admissions (1, 533 patients). Interventions: The host response was evaluated on ICU admission by measuring 19 plasma biomarkers reflecting organ systems implicated in sepsis pathogenesis (1, 205 admissions) and by applying genome-wide blood gene expression profiling (582 admissions). Measurements and Main Results: Sepsis patients admitted to the ICU were more frequently males (61.0%; p < 0.0001 vs females). Baseline characteristics were not different between genders. Urosepsis was more common in females; endocarditis and mediastinitis in men. Disease severity was similar throughout ICU stay. Mortality was similar up to 1 year after ICU admission, and gender was not associated with 90-day mortality in multivariate analyses in a variety of subgroups. Although plasma proteome analyses (including systemic inflammatory and cytokine responses, and activation of coagulation) were largely similar between genders, females showed enhanced endothelial cell activation; this difference was virtually absent in patients more than 55 years old. More than 80% of the leukocyte blood gene expression response was similar in male and female patients. Conclusions: The host response and outcome in male and female sepsis patients requiring ICU admission are largely similar. Abstract : Supplemental Digital Content is available in the text.