Sex differences in the SOFA score of ICU patients with sepsis or septic shock: a nationwide analysis


Background:The Sequential Organ Failure Assessment (SOFA) score is an important tool in diagnosing sepsis and quantifying organ dysfunction. However, despite emerging evidence of differences in sepsis pathophysiology between women and men, sex is currently not being considered in the SOFA score. We aimed to investigate potential sex‐specific differences in organ dysfunction, as measured by the SOFA score, in patients with sepsis or septic shock and explore outcome associations.序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)是一种重要的工具,用于诊断脓毒症和量化器官功能障碍。然而,尽管有越来越多的证据表明脓毒症的病理生理在女性和男性之间存在差异,但目前SOFA评分并未考虑性别因素。本研究旨在调查脓毒症症或脓毒性休克患者的器官功能障碍(通过SOFA评分衡量)中可能存在的性别特异性差异,并探索其与结果的关联。

Methods:Retrospective analysis of sex‐specific differences in the SOFA score of prospectively enrolled ICU patients with sepsis or septic shock admitted to one of 85 certified Swiss ICUs between 01/2021 and 12/2022.回顾性分析了2021年1月至2022年12月期间,入住瑞士85个认证ICU之一的脓毒症症或脓毒性休克的ICU患者的性别特异性SOFA评分差异。这些患者是前瞻性招募的。

Results:Of 125,782 patients, 5947 (5%) were admitted with a clinical diagnosis of sepsis (2244, 38%) or septic shock (3703, 62%). Of these, 5078 (37% women) were eligible for analysis. A statistically significant difference of the total SOFA score on admission was found between women (mean 7.5 ± SD 3.6 points) and men (7.8 ± 3.6 points, Wilcoxon rank‐sum p < 0.001). This was driven by differences in the coagulation (p = 0.008), liver (p < 0.001) and renal (p < 0.001) SOFA components. Differences between sexes were more prominent in younger patients < 52 years of age (women 7.1 ± 4.0 points vs men 8.1 ± 4.2 points, p = 0.004). No sex‐specific differences were found in ICU length of stay (women median 2.6 days (IQR 1.3–5.3) vs men 2.7 days (IQR 1.2–6.0), p = 0.13) and ICU mortality (women 14% vs men 15%,p = 0.17).在125,782名患者中,5947名(5%)因临床诊断为脓毒症(2244名,38%)或脓毒性休克(3703名,62%)而入院。其中,5078名患者(37%为女性)符合分析条件。在入院时,女性(平均7.5 ± 标准差3.6分)和男性(7.8 ± 3.6分,Wilcoxon秩和检验p < 0.001)的总SOFA评分存在统计学上的显著差异。这种差异主要是由凝血(p = 0.008)、肝脏(p < 0.001)和肾脏(p < 0.001)SOFA组分的差异所驱动的。在52岁以下的年轻患者中,性别差异更为明显(女性7.1 ± 4.0分 vs 男性8.1 ± 4.2分,p = 0.004)。在ICU住院时间(女性中位数2.6天(四分位间距1.3–5.3)vs 男性2.7天(四分位间距1.2–6.0),p = 0.13)和ICU死亡率(女性14% vs 男性15%,p = 0.17)方面,未发现性别特异性差异。

Conclusion:Sex‐specific differences exist in the SOFA score of patients admitted to a Swiss ICU with sepsis or septic shock, particularly in laboratory‐based components. Although the clinical meaningfulness of these differences is unclear, a reevaluation of sex‐specific thresholds for SOFA score components is warranted in an attempt to make more accurate and individualised classifications.瑞士ICU入院的脓毒症或脓毒性休克患者的SOFA评分存在性别特异性差异,特别是在基于实验室的组分中。尽管这些差异的临床意义尚不清楚,但有必要重新评估SOFA评分组分的性别特异性阈值,以期做出更准确和个性化的分类


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