Association of Gender With Outcome and Host Response in Critically Ill Sepsis Patients

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.