Top ten list in sepsis.

Schroder and colleagues expand our growing knowledge of genetic predisposition to septic shock by examining the relationship of gender to tumor necrosis factor (TNF)gene Nco1 polymorphism. Several recent reports indicate that patients who possess the TNF2 homozygous genotype for this polymorphism have a higher incidence of severe sepsis, higher TNFserum concentrations, and a lower likelihood of survival once sepsis develops. In this prospective study of 201 patients with severe sepsis, the 68 women had a higher survival rate than the men, but no association of survival to different genotypes was found in women. In contrast, the mortality rate was significantly increased in 133 men who were homozygous for TNF2 compared to other genotypes. Since previous sepsis studies from the same investigators demonstrated higher interleukin (IL)-10 levels in women and higher TNFlevels in men, it may be that genetically determined patterns of cytokine response to injury or infection may differ among the sexes and may influence outcome.