Experimental data show a natural survival advantage after polymicrobial sepsis for www.selleckchem.com/products/Trichostatin-A.html women [1], but human studies focusing the impact of gender on sepsis-related mortality gave inconsistent results, showing a lower [7,19], equal [26,27] or higher [5,28-30] mortality rate. Vincent et al. [29] reported, in their European multicenter cohort, higher mortality for women with sepsis than for men [29]. Combes et al. [3], studying ICU patients with sepsis, reported that female gender predicted mortality, although in the univariate analysis, mortality was not significantly different. Seymour et al. [28] reported a higher mortality rate for women with Fournier gangrene, with more male patients surviving the septic phase. In contrast to this, Adrie et al.
[29] found a survival advantage in women older than 50 years, which is also opposed to our findings [19]. In that study, Adrie et al. postulated women older than 50 years to be postmenopausal without measuring hormone status, which seems to be of high importance. Further on, they included only community-acquired sepsis and predominantly medical patients, which is a difference from our and other study populations. The results of the O/E mortality rate suggest that the SAPS-II score provides the most reliable predictive values for the subgroup of women with sepsis. It is an interesting finding that might indicate a limitation of intensive care scoring systems.In our study, we also analyzed evolution of TISS-28 scoring for men and women. We found consistent differences between genders being statistically significant.
As TISS-28 is a surrogate parameter for intensity of care, our results coincide with the findings that men receive more invasive procedures than do women, regardless of the reason of admission or procedures [7,8]. Conversely, TISS-28 was thought to be used to compare predicted survival in different populations [21,22]. Based on these findings, it might be difficult to use scoring systems not incorporating gender as an independent factor for ICU mortality.LimitationsOur study has several limitations. First, data were collected in one tertiary care center but with three ICUs with a very mixed population.Second, we did not measure sex-hormone levels and did not stratify for age, because postmenopausal status is difficult to assess without measuring sex hormones.
As experimental data showed an influence of sex hormones on outcome, this might alter our results. These data advocate further prospective trials with specific focus on this issue.Third, we did not take into account marital status, which is meant to have an influence on mortality from sepsis [28]. Although having probably the same impact on both genders, the fact that data were collected only during winter and spring could theoretically represent another limitation.Fourth, Dacomitinib 81.8% of our patients are surgical, so results for medical patients might be different.