Sequential organ failure assessment score (SOFA) scores differ between genders in a sepsis cohort : cause or effect?

Background: Controversy exists regarding the influence of gender on sepsis events and out­come. Epidemiological data from other countries may not always apply to local circum­stances. The aim of this study was to identify gender differences in patient characteristics, treatment and outcome related to the occurrence of sepsis at admission to the ICU. Methods: A prospective observational cohort study on patients admitted to the ICU over a three-year period fulfilling sepsis criteria during the first 24 hours. Demographic data, APACHE II score, SOFA score, TISS 76, aetiology, length of stay (LOS), mortality rate and aspects of treatment were collected and then analysed with respect to gender differences. Results: There were no gender related differences in mortality or length of stay. Early organ dysfunction assessed as SOFA score at admission was a stronger risk factor for hospital mor­tality for women than for men. This discrepancy was mainly associated with the coagulation sub score. CRP-levels differed between genders in relation to hospital mortality. Infection from the abdominopelvic region was more common among women whereas infection from skin or skin structures were more common in men. Conclusion: In this cohort, gender was not associated with increased mortality during a two year follow up period. SOFA score at ICU-admission was a stronger risk factor for hospital mortality for women than for men. The discrepancy was mainly related to the coagulation SOFA sub score. Together with differences in CRP-levels this may suggest differences in inflammatory response patterns between genders.