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Influence of Gender on the Outcome of Severe Sepsis^*

A Reappraisal

Christophe Adrie, MD, PhD; Elie Azoulay, MD, PhD; Adrien Francais, PhD; Christophe Clec’h, MD; Loic Darques, MD; Carole Schwebel, MD; Didier Nakache, PhD; Samir Jamali, MD; Dany Goldgran-Toledano, MD; Maïté Garrouste-Orgeas, MD; Jean François Timsit, MD, PhD; for the OutcomeRea Study Group

^* From the Medical-Surgical ICU (Drs. Adrie and Darques), Delafontaine Hospital, Saint Denis; Medical ICU (Dr. Azoulay), Saint Louis Teaching Hospital, Paris; INSERM U823 (Drs. Francais and Timsit), Epidemiology of Cancer and Severe Illnesses, Albert Bonniot Institute, Grenoble; Medical-Surgical ICU (Dr. Clec’h), Avicenne Teaching Hospital, Bobigny; Medical ICU (Dr. Schwebel), Albert Michallon Teaching Hospital, Grenoble; Laboratory of Computer Sciences (Dr. Nakache), Centre National des Arts et Métiers, Paris; Medical-Surgical ICU (Dr. Jamali), Dourdan Hospital, Dourdan; Medical-Surgical ICU (Dr. Goldgran-Toledano), Gonesse Hospital, Gonesse; and Medical-Surgical ICU (Dr. Garrouste-Orgeas), Saint Joseph Hospital, Paris, France. A list of participants is given in the ^Appendix.

Correspondence to: Christophe Adrie, MD, PhD, Service de Réanimation Polyvalente, Hôpital Delafontaine, 2, rue du Dr Delafontaine, 93205 Sant Denis, France; e-mail: christophe.adrie{at}outcomerea.org

Abstract

Background: The influence of gender on survival of patients with severe sepsis is unclear. Earlier studies suggested better survival in women, possibly related to the sex-steroid profile.

Methods: To investigate whether mortality from severe sepsis was higher in men than in women and whether the difference varied with menopausal status, we studied 1,692 patients with severe sepsis included in the OutcomeRea database over an 8-year period. We conducted a nested case-control study, accurately matching men and women on three criteria: a death propensity score, age, and center. Subgroup analyses were performed on individuals 50 years old (men vs premenopausal women) and > 50 years old (men vs postmenopausal women).

Results: We matched 1,000 men to 608 women with severe sepsis before and after adjustment for confounding factors (ie, chronic respiratory failure; metastatic cancer; immunocompromised status; emergency surgery, acute respiratory failure, and shock at admission; urinary tract infection; and type of microorganism). Overall hospital mortality was significantly lower in women (adjusted odds ratio [OR], 0.75; 95% confidence interval [CI], 0.57 to 0.97; p = 0.02). In the group > 50 years old (481 women, 778 men), hospital mortality was significantly lower in women (OR, 0.69; 95% CI, 0.52 to 0.93; p = 0.014). Hospital mortality was not significantly different between men and women in the younger group (127 women, 222 men) [OR, 1.01; 95% CI, 0.52 to 1.97; p = 0.98]. Level of care, as assessed using the nine equivalents of nursing manpower use score, was identical in men and women.

Conclusions: Among individuals > 50 years old with severe sepsis, women have a lower risk of hospital mortality than men.

Key Words: critical care • gender • outcome • sepsis • severe sepsis • therapeutic interventions

Related Editorial

Sepsis and Sex: Can We Look Beyond Our Hormones?

David M. Berkowitz and Greg S. Martin
Chest 2007 132: 1725-1727. [Full Text] [PDF]

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				D. M. Berkowitz and G. S. Martin Sepsis and Sex: Can We Look Beyond Our Hormones? Chest, December 1, 2007; 132(6): 1725 - 1727. [Full Text] [PDF]