{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:28:15Z","timestamp":1793532495131,"version":"4.5.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Differences in inflammatory responses between men and women may contribute to sex disparities in cardiac surgery outcomes. We investigated how sex differences influence systemic inflammatory response syndrome (SIRS) and adverse outcomes after cardiac surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A single-centre retrospective cohort study of patients undergoing cardiac surgery from 2018 to 2020 was performed. SIRS was defined as per the American College of Chest Physicians\/Society of Critical Care Medicine. Predictors of SIRS and composite adverse outcomes (death, transient ischaemic attack\/stroke, renal therapy, bleeding, postcardiotomy mechanical circulatory support, prolonged Intensive Care Unit stay) were evaluated using multivariable logistic regression. Mediation effects of SIRS were assessed using structural equation modelling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The cohort included 1005 patients, of whom 299 (29.8%) were women. SIRS occurred in 28.1% of patients, and 12.7% experienced the composite end point. Female sex was significantly associated with SIRS (odds ratio 1.56; 95% confidence interval 1.12\u20132.18, P\u2009=\u20090.009) and the composite outcome (odds ratio 1.72; 95% confidence interval 1.10\u20132.69, P\u2009=\u20090.017). Baseline left ventricular dysfunction and intraoperative hyperlactatemia were additional common predictors. SIRS mediated 50.8% of the effect of female sex, 17.0% of left ventricular dysfunction and 30.9% of intraoperative hyperlactatemia on the composite outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Female sex is independently associated with postoperative SIRS and poorer outcomes. Systemic inflammation, preoperative anaemia and procedural hyperlactatemia are potentially modifiable factors in the mechanisms through which female sex appears to worsen outcome after cardiac surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf066","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T18:54:01Z","timestamp":1741805641000},"source":"Crossref","is-referenced-by-count":7,"title":["Sex-related differences in systemic inflammatory response and outcomes after cardiac surgery and cardiopulmonary bypass"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-747X","authenticated-orcid":false,"given":"Enrico","family":"Squiccimarro","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia , Foggia,","place":["Italy"]},{"name":"Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre , Maastricht,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Lorusso","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre , Maastricht,","place":["Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht , Maastricht,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4318-2620","authenticated-orcid":false,"given":"Vito","family":"Margari","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research , Bari,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8148-2640","authenticated-orcid":false,"given":"Cataldo","family":"Labriola","sequence":"additional","affiliation":[{"name":"Division of Cardiac Anesthesia and Intensive Care, Montevergine Hospital, GVM Care & Research , Mercogliano,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-0388","authenticated-orcid":false,"given":"Richard","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, McMaster University , Hamilton, ON,","place":["Canada"]},{"name":"Population Health Research Institute , Hamilton, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2261-7098","authenticated-orcid":false,"given":"Domenico","family":"Paparella","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia , Foggia,","place":["Italy"]},{"name":"Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research , Bari,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"2025032209263031300_ivaf066-B1","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.athoracsur.2022.12.033","article-title":"The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2022 update on outcomes and research","volume":"115","author":"Kim","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2025032209263031300_ivaf066-B2","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/S1010-7940(01)01099-5","article-title":"Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update","volume":"21","author":"Paparella","year":"2002","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025032209263031300_ivaf066-B3","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/aor.14171","article-title":"Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass","volume":"46","author":"Squiccimarro","year":"2022","journal-title":"Artif Organs"},{"key":"2025032209263031300_ivaf066-B4","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1053\/j.jvca.2019.01.043","article-title":"Prevalence and clinical impact of systemic inflammatory reaction after cardiac surgery","volume":"33","author":"Squiccimarro","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025032209263031300_ivaf066-B5","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00011-007-6198-z","article-title":"Modulation of the inflammatory response by estrogens with focus on the endothelium and its interactions with leukocytes","volume":"56","author":"Nilsson","year":"2007","journal-title":"Inflamm Res"},{"key":"2025032209263031300_ivaf066-B6","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1111\/j.1476-5381.2012.02146.x","article-title":"Role and interactions of annexin A1 and oestrogens in the manifestation of sexual dimorphisms in cerebral and systemic inflammation","volume":"169","author":"Hughes","year":"2013","journal-title":"Br J Pharmacol"},{"key":"2025032209263031300_ivaf066-B7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1038\/gene.2009.12","article-title":"Stronger inflammatory\/cytotoxic T cell response in women identified by microarray analysis","volume":"10","author":"Hewagama","year":"2009","journal-title":"Genes Immun"},{"key":"2025032209263031300_ivaf066-B8","doi-asserted-by":"crossref","first-page":"17455065211022262","DOI":"10.1177\/17455065211022262","article-title":"Immune system and COVID-19 by sex differences and age","volume":"17","author":"Ciarambino","year":"2021","journal-title":"Womens Health (Lond)"},{"key":"2025032209263031300_ivaf066-B9","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1161\/CIRCULATIONAHA.121.056025","article-title":"Cardiac surgery in women in the current era: what are the gaps in care?","volume":"144","author":"Cho","year":"2021","journal-title":"Circulation"},{"key":"2025032209263031300_ivaf066-B10","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1093\/ejcts\/ezab369","article-title":"Sex-specific differences and postoperative outcomes of minimally invasive and sternotomy valve surgery","volume":"61","author":"Moscarelli","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025032209263031300_ivaf066-B11","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/00003246-199206000-00025","article-title":"American College of Chest Physicians\/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis","volume":"20","author":"Bone","year":"1992","journal-title":"Crit Care Med"},{"key":"2025032209263031300_ivaf066-B12","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s41073-016-0007-6","article-title":"Sex and gender equity in research: rationale for the SAGER guidelines and recommended use","volume":"1","author":"Heidari","year":"2016","journal-title":"Res Integr Peer Rev"},{"key":"2025032209263031300_ivaf066-B13","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.athoracsur.2009.05.056","article-title":"The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2\u2014isolated valve surgery","volume":"88","author":"O\u2019Brien","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"2025032209263031300_ivaf066-B14","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"Nashef","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025032209263031300_ivaf066-B15","doi-asserted-by":"crossref","first-page":"e008902","DOI":"10.1161\/JAHA.118.008902","article-title":"Prevalence and long-term survival after coronary artery bypass grafting in women and men with heart failure and preserved versus reduced ejection fraction","volume":"7","author":"Sun","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025032209263031300_ivaf066-B16","doi-asserted-by":"crossref","first-page":"e013260","DOI":"10.1161\/JAHA.119.013260","article-title":"Sex differences in long-term survival after major cardiac surgery: a population-based cohort study","volume":"8","author":"Johnston","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2025032209263031300_ivaf066-B17","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/S0022-5223(03)00355-6","article-title":"Gender-related differences in morbidity and mortality during combined valve and coronary surgery","volume":"126","author":"Ibrahim","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025032209263031300_ivaf066-B18","first-page":"42","article-title":"Gender differences in mitral valve surgery","volume":"61","author":"Seeburger","year":"2013","journal-title":"Thorac Cardiovasc Surg"},{"key":"2025032209263031300_ivaf066-B19","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.amjcard.2016.05.013","article-title":"Transcatheter aortic valve replacement in women versus men (from the US CoreValve Trials)","volume":"118","author":"Forrest","year":"2016","journal-title":"Am J Cardiol"},{"key":"2025032209263031300_ivaf066-B20","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1213\/ANE.0000000000006076","article-title":"Sex differences in in-hospital mortality after open cardiac valve surgery","volume":"135","author":"Bradley","year":"2022","journal-title":"Anesth Analg"},{"key":"2025032209263031300_ivaf066-B21","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1161\/CIRCULATIONAHA.118.035805","article-title":"Sex-related differences in patients undergoing thoracic aortic surgery","volume":"139","author":"Chung","year":"2019","journal-title":"Circulation"},{"key":"2025032209263031300_ivaf066-B22","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.jtcvs.2016.10.090","article-title":"Aortic root surgery with circulatory arrest: predictors of prolonged postoperative hospital stay","volume":"153","author":"Preventza","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025032209263031300_ivaf066-B23","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.athoracsur.2021.04.069","article-title":"Sex differences in ascending aortic and arch surgery: a propensity-matched comparison of 1153 pairs","volume":"113","author":"Preventza","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"2025032209263031300_ivaf066-B24","first-page":"e6","article-title":"Heart disease and stroke statistics\u20142013 update: a report from the American Heart Association","volume":"127","author":"Go","year":"2013","journal-title":"Circulation"},{"key":"2025032209263031300_ivaf066-B25","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1161\/hc1002.105133","article-title":"Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women","volume":"105","author":"Vaccarino","year":"2002","journal-title":"Circulation"},{"key":"2025032209263031300_ivaf066-B26","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.athoracsur.2007.11.022","article-title":"Do women currently receive the same standard of care in coronary artery bypass graft procedures as men? A propensity analysis","volume":"85","author":"Parolari","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2025032209263031300_ivaf066-B27","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1053\/j.jvca.2019.02.040","article-title":"Sex difference in coronary artery bypass grafting: preoperative profile and early outcome","volume":"33","author":"Ter Woorst","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025032209263031300_ivaf066-B28","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.jacc.2023.12.032","article-title":"Intraoperative anemia mediates sex disparity in operative mortality after coronary artery bypass grafting","volume":"83","author":"Harik","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"2025032209263031300_ivaf066-B29","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1002\/bjs.9898","article-title":"Patient blood management to reduce surgical risk","volume":"102","author":"Clevenger","year":"2015","journal-title":"Br J Surg"},{"key":"2025032209263031300_ivaf066-B30","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.bja.2023.06.062","article-title":"Determining sex-specific preoperative haemoglobin levels associated with intraoperative red blood cell transfusion in cardiac surgery: a retrospective cohort study","volume":"131","author":"Cavalli","year":"2023","journal-title":"Br J Anaesth"},{"key":"2025032209263031300_ivaf066-B31","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.athoracsur.2014.04.124","article-title":"Incremental value of anemia in cardiac surgical risk prediction with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II model","volume":"98","author":"Scrascia","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2025032209263031300_ivaf066-B32","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1378\/chest.13-1023","article-title":"Modified criteria for the systemic inflammatory response syndrome improves their utility following cardiac surgery","volume":"145","author":"MacCallum","year":"2014","journal-title":"Chest"},{"key":"2025032209263031300_ivaf066-B33","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2024.12.013","article-title":"Impact of inflammation after cardiac surgery on 30-day mortality and machine learning risk prediction","author":"Squiccimarro","year":"2024","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025032209263031300_ivaf066-B34","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1053\/j.jvca.2023.12.017","article-title":"Prolonged systemic inflammatory response syndrome after cardiac surgery","volume":"38","author":"Viikinkoski","year":"2024","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025032209263031300_ivaf066-B35","doi-asserted-by":"crossref","first-page":"394","DOI":"10.2459\/JCM.0000000000001309","article-title":"Prognostic value of systemic inflammatory response syndrome after transcatheter aortic valve implantation","volume":"23","author":"Monosilio","year":"2022","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2025032209263031300_ivaf066-B36","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1007\/s00392-023-02316-y","article-title":"Incidence of systemic inflammatory response syndrome and patient outcome following transcatheter edge-to-edge mitral valve repair","volume":"113","author":"Syryca","year":"2024","journal-title":"Clin Res Cardiol"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf066\/62387356\/ivaf066.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/3\/ivaf066\/62387356\/ivaf066.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/3\/ivaf066\/62387356\/ivaf066.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T11:27:01Z","timestamp":1742729221000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf066\/8071870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,5]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf066","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2025,3]]},"article-number":"ivaf066"}}