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Abstract：
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.
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.
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).
CONCLUSIONS: 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.
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.
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).
CONCLUSIONS: 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.
摘要：
背景：序贯器官衰竭评估（SOFA）评分是诊断败血症和量化器官功能障碍的重要工具。然而,尽管有新的证据表明女性和男性在败血症病理生理学上存在差异，性别目前不在SOFA评分中。我们旨在调查器官功能障碍的潜在性别差异，以SOFA评分衡量，并探讨脓毒症或脓毒性休克患者的预后相关性。
方法：回顾性分析2021年1月至2022年12月12日期间，在85个认证瑞士ICU之一中，前瞻性纳入ICU的脓毒症或脓毒性休克患者的SOFA评分的性别差异。
结果：在125,782名患者中，5947（5％）入院，临床诊断为败血症（2244，38％）或败血症性休克（3703，62％）。其中,5078（37％的女性）有资格进行分析。女性（平均7.5±SD3.6分）和男性（7.8±3.6分，威尔科克森秩和p<0.001)。这是由凝血差异驱动的（p=0.008），肝脏（p<0.001）和肾脏（p<0.001）SOFA成分。年龄<52岁的年轻患者之间的性别差异更为明显（女性7.1±4.0分，男性8.1±4.2分，p=0.004)。ICU住院时间没有发现性别差异（女性中位数2.6天（IQR1.3-5.3）与男性2.7天（IQR1.2-6.0），p=0.13）和ICU死亡率（女性14%vs男性15%，p=0.17）。
结论：瑞士ICU脓毒症或脓毒性休克患者的SOFA评分存在性别差异，特别是在基于实验室的组件中。尽管这些差异的临床意义尚不清楚，有必要对SOFA评分成分的性别阈值进行重新评估,以便做出更准确和个性化的分类.
方法：回顾性分析2021年1月至2022年12月12日期间，在85个认证瑞士ICU之一中，前瞻性纳入ICU的脓毒症或脓毒性休克患者的SOFA评分的性别差异。
结果：在125,782名患者中，5947（5％）入院，临床诊断为败血症（2244，38％）或败血症性休克（3703，62％）。其中,5078（37％的女性）有资格进行分析。女性（平均7.5±SD3.6分）和男性（7.8±3.6分，威尔科克森秩和p<0.001)。这是由凝血差异驱动的（p=0.008），肝脏（p<0.001）和肾脏（p<0.001）SOFA成分。年龄<52岁的年轻患者之间的性别差异更为明显（女性7.1±4.0分，男性8.1±4.2分，p=0.004)。ICU住院时间没有发现性别差异（女性中位数2.6天（IQR1.3-5.3）与男性2.7天（IQR1.2-6.0），p=0.13）和ICU死亡率（女性14%vs男性15%，p=0.17）。
结论：瑞士ICU脓毒症或脓毒性休克患者的SOFA评分存在性别差异，特别是在基于实验室的组件中。尽管这些差异的临床意义尚不清楚，有必要对SOFA评分成分的性别阈值进行重新评估,以便做出更准确和个性化的分类.
