title: Markov cohort simulation study reveals evidence for sex-based risk difference in intensive care unit patients.
abstract: BACKGROUND
  Despite great advances in intensive care medicine, sepsis still is the leading cause of death. Different strategies have been developed to file the patient data into scoring systems, primarily to predict the outcome. The Markov simulation-predominantly used in economic science to describe chains of events depending on and influencing each other-seems to be an interesting and new approach in analyzing the course of disease of critically ill patients in an intensive care unit (ICU). Using such a Markov model, this study analyzes data from 660 surgical ICU patients, 44 of whom died of sepsis.
  
  
  METHODS
  A three-state Markov model (integrating sepsis, adult respiratory distress syndrome, and mortality) was constructed to describe the course of disease of critically ill patients in defined cycles and to develop the risk profile of different groups of patients. The model enables the comparison between age- and sex-related survival rates and shows the difference in life expectancy compared with an average untreated standard population.
  
  
  RESULTS
  Women aged up to 30 years (G1F) show the best prognosis (mortality after 19 cycles 8.3%). On the contrary, the corresponding male group (G1M) demonstrates the worst outcome (mortality after 19 cycles 57.7 %).
  
  
  CONCLUSIONS
  The findings of this study fit into the current discussion that female patients are better positioned to meet the challenge of sepsis.
authors.affiliation: Department of Surgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bäuerle
authors.forename: A
authors.initials: A
authors.lastname: Rücker
authors.forename: T C
authors.initials: TC
authors.lastname: Schmandra
authors.forename: K
authors.initials: K
authors.lastname: Holzer
authors.forename: A
authors.initials: A
authors.lastname: Encke
authors.forename: E
authors.initials: E
authors.lastname: Hanisch
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005544:Forecasting; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000401:mortality; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D012737:Sex Factors; D015996:Survival Rate