title: Sex- and diagnosis-dependent differences in mortality and admission cytokine levels among patients admitted for intensive care.
abstract: OBJECTIVE
  To investigate the role of sex on cytokine expression and mortality in critically ill patients.
  
  
  METHODS
  A cohort of patients admitted to were enrolled and followed over a 5-year period.
  
  
  METHODS
  Two university-affiliated hospital surgical and trauma ICUs.
  
  
  METHODS
  Patients 18 years old and older admitted for at least 48 hours to the surgical or trauma ICU.
  
  
  METHODS
  Observation only.
  
  
  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.
authors.affiliation: 1Department of Surgery, University of Virginia Health System, Charlottesville, VA. 2Department of Surgery, University of Minnesota, Minneapolis, MN. 3Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. 4Department of Surgery, University of Washington, Seattle, WA. 5Department of Surgery, University of Alabama-Birmingham, Birmingham, AL. 6Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Guidry
authors.forename: Brian R
authors.initials: BR
authors.lastname: Swenson
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Davies
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Dossett
authors.forename: Kimberley A
authors.initials: KA
authors.lastname: Popovsky
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
authors.forename: Heather L
authors.initials: HL
authors.lastname: Evans
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Metzger
authors.forename: Traci L
authors.initials: TL
authors.lastname: Hedrick
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Tache-Léon
authors.forename: Tjasa
authors.initials: T
authors.lastname: Hranjec
authors.forename: Irshad H
authors.initials: IH
authors.lastname: Chaudry
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology; D016207:Cytokines / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D016207:Cytokines