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Influence of Gender on the Outcome of Severe Sepsis: a Reappraisal

¹Medical-Surgical ICU, Delafontaine Hospital, Saint Denis, France ²Medical ICU, Saint Louis Teaching Hospital, Paris, France ³INSERM U823, Epidemiology of Cancer and Severe Illnesses, Albert Bonniot Institute Grenoble, France ⁴Medical-Surgical ICU, Avicenne Teaching Hospital, Bobigny, France ⁵Medical ICU, Albert Michallon Teaching Hospital, Grenoble, France ⁶Laboratory of Computer Sciences, Centre National des Arts et Métiers, Paris, France ⁷Medical-Surgical ICU, Dourdan Hospital, Dourdan, France ⁸Medical-Surgical ICU, Gonesse Hospital, Gonesse, France ⁹Medical-Surgical ICU, Saint Joseph Hospital, Paris, France

christophe.adrie{at}outcomerea.org

Abstract

BackgroundThe 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 1692 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 centre. Subgroup analyses were performed on individuals 50 years (men vs. premenopausal women) and older than 50 years (men vs. postmenopausal women). Results: We matched 1000 men to 608 women with severe sepsis before and after adjustment for confounding factors (i.e., 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 OR: 0.75 [0.57-0.97], P=0.02). In the group older than 50 years (481 women, 778 men), hospital mortality was significantly lower in women (OR: 0.69 [0.52-0.93, P=0.014]). Hospital mortality was not significantly different between men and women in the younger group (127 women, 222 men) (OR: 1.01 [0.52-1.97, P=0.98]). Level of care, as assessed using the Nine Equivalents of Nursing Manpower Use Score (NEMS), was identical in men and women. Conclusions: Among individuals older than 50 years with severe sepsis, women have a lower risk of hospital mortality than men.

Key Words: sepsis • severe sepsis • outcome • gender • critical care • 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]