Sex- and diagnosis-dependent differences in mortality and admission cytokine levels among patients admitted for intensive care

Christopher A. Guidry, Brian R. Swenson, Stephen W. Davies, Lesly A. Dossett, Kimberley A. Popovsky, Hugo Bonatti, Heather L. Evans, Rosemarie Metzger, Traci L. Hedrick, Carlos A. Tache-Léon, Tjasa Hranjec, Irshad H. Chaudry, Timothy L. Pruett, Addison K. May, Robert G. Sawyer

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objectives: To investigate the role of sex on cytokine expression and mortality in critically ill patients. Design: A cohort of patients admitted to were enrolled and followed over a 5-year period. Setting: Two university-affiliated hospital surgical and trauma ICUs. Patients: Patients 18 years old and older admitted for at least 48 hours to the surgical or trauma ICU. Interventions: Observation only. Measurements and Main Results: Major outcomes included admission cytokine levels, prevalence of ICU-acquired infection, and mortality during hospitalization conditioned on trauma status and sex. The final cohort included 2,291 patients (1,407 trauma and 884 nontrauma). The prevalence of ICU-acquired infection was similar for men (46.5%) and women (44.5%). All-cause in-hospital mortality was 12.7% for trauma male patient and 9.1% for trauma female patient (p = 0.065) and 22.9% for nontrauma male patients and 20.6% for nontrauma female patients (p = 0.40). Among trauma patients, logistic regression analysis identified female sex as protective for all-cause mortality (odds ratio, 0.57). Among trauma patients, men had significantly higher admission serum levels of interleukin-2, interleukin-12, interferon-γ, and tumor necrosis factor-α, and among nontrauma patients, men had higher admission levels of interleukin-8 and tumor necrosis factor-α. Conclusions: The relationship between sex and outcomes in critically ill patients is complex and depends on underlying illness. Women appear to be better adapted to survive traumatic events, while sex may be less important in other forms of critical illness. The mechanisms accounting for this gender dimorphism may, in part, involve differential cytokine responses to injury, with men expressing a more robust proinflammatory profile.

Original languageEnglish (US)
Pages (from-to)1110-1120
Number of pages11
JournalCritical care medicine
Volume42
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • Acute Physiology and Chronic Health Evaluation II
  • critical care
  • gender
  • hospital mortality
  • hospitalization/statistics and numerical data
  • humans
  • infection
  • logistic models
  • man
  • risk factors
  • sex
  • sex factors
  • treatment outcome
  • woman

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Guidry, C. A., Swenson, B. R., Davies, S. W., Dossett, L. A., Popovsky, K. A., Bonatti, H., Evans, H. L., Metzger, R., Hedrick, T. L., Tache-Léon, C. A., Hranjec, T., Chaudry, I. H., Pruett, T. L., May, A. K., & Sawyer, R. G. (2014). Sex- and diagnosis-dependent differences in mortality and admission cytokine levels among patients admitted for intensive care. Critical care medicine, 42(5), 1110-1120. https://doi.org/10.1097/CCM.0000000000000139