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Sex-related mortality differences in young adult septic shock patients

  • Alberto Zangrillo1,2,†
  • Federica Morselli2,†
  • Emanuela Biagioni3
  • Roberta Di Stella4
  • Irene Coloretti3
  • Elena Moizo2
  • Valentina Paola Plumari2
  • Giacomo Monti2
  • Giovanni Borghi2
  • Andrea Salonia1,5
  • Giada Almirante6
  • Davide Maraggia4
  • Massimo Zambon7
  • Nicola Langiano8
  • Agostino Roasio9
  • Laura Pasin10
  • Milena Mucci2
  • Paolo Federico Beccaria2
  • Nicola Pasculli2
  • Martina Baiardo Redaelli2
  • Ottavia Pallanch2
  • Giulia Gallo1
  • Giovanni Real1
  • Marta Nava1
  • Sophie Venturelli3
  • Martina Tosi3
  • Elena Munari3
  • Maria Grazia Visconti7
  • Silvia Perno9
  • Massimo Girardis3
  • Giovanni Landoni1,2,*,

1School of Medicine, Vita-Salute San Raffaele University, 87046 Milan, Italy

2Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20151 Milan, Italy

3Department of Anesthesia and Intensive Care, University Hospital of Modena, 87106 Modena, Italy

4Università degli Studi dell’Insubria, Azienda Ospedaliera Ospedale di Circolo e Fondazione, 16021 Macchi- Varese, Italy

5Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, 87046 Milan, Italy

6Department of Gynecology and Obstetrics, IRCCS San Raffaele Scientific Institute, 20151 Milan, Italy

7Department of Anesthesia and Intensive Care Medicine, Cernusco sul Naviglio Hospital, ASST Melegnano e Martesana, 20063 Milan, Italy

8Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, 33100 Udine, Italy

9Department of Anesthesia and Intensive Care, “Cardinal Massaia” Hospital, 14100 Asti, Italy

10Department of Anesthesia and Intensive Care, 35139 Padua, Italy

DOI: 10.22514/sv.2022.017 Vol.19,Issue 1,January 2023 pp.50-56

Submitted: 18 October 2021 Accepted: 28 December 2021

Published: 08 January 2023

*Corresponding Author(s): Giovanni Landoni E-mail:

† These authors contributed equally.


Septic shock survival rate and host immune response are intimately interlaced. In the last years, biological and pre-clinical studies demonstrated sex-specific differences in the immune response to infection. In the hypothesis that survival rate is related to the hormonal framework, the aim of the present study was to observe sex-specific differences in 28-day mortality rate between women of childbearing potential and same-age men. This multicenter study was conducted in six Italian intensive care units (ICUs). We enrolled consecutive patients ≤ 55 years old admitted to the Intensive Care Unit from January 2011 to January 2020, who were diagnosed with septic shock at the time of ICU admission or during the ICU stay. We gathered baseline characteristics and outcomes. The primary outcome was 28-day mortality; secondary outcomes included ICU mortality, in-hospital mortality and length of stay in the ICU and in the hospital. Moreover, data from >55 years old patients were collected and analyzed. We enrolled 361 young patients with septic shock: 215 were males (60%) and 146 females (40%). While baseline and ICU characteristics were similar between the two groups, males had a higher 28-day mortality rate (39.5% vs. 29%, p = 0.035), ICU mortality rate (49%vs. 38%, p = 0.040) and hospital mortality rate (61% vs. 50%, p = 0.040) as compared to females. Findings were confirmed in patients with septic shock at ICU admission. Young adult females developed septic shock less frequently than young males, displaying a reduced mortality rate as compared to that of their same-age male counterpart. These findings may stimulate future research and therapies.


Sex; Gender; Septic shock; Intensive Care Unit; Mortality

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Alberto Zangrillo,Federica Morselli,Emanuela Biagioni,Roberta Di Stella,Irene Coloretti,Elena Moizo,Valentina Paola Plumari,Giacomo Monti,Giovanni Borghi,Andrea Salonia,Giada Almirante,Davide Maraggia,Massimo Zambon,Nicola Langiano,Agostino Roasio,Laura Pasin,Milena Mucci,Paolo Federico Beccaria,Nicola Pasculli,Martina Baiardo Redaelli,Ottavia Pallanch,Giulia Gallo,Giovanni Real,Marta Nava,Sophie Venturelli,Martina Tosi,Elena Munari,Maria Grazia Visconti,Silvia Perno,Massimo Girardis,Giovanni Landoni. Sex-related mortality differences in young adult septic shock patients. Signa Vitae. 2023. 19(1);50-56.


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