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

Adrie C, Azoulay E, Francais A, Clec'h C, Darques L, Schwebel C, Nakache D, Jamali S, Goldgran-Toledano D, Garrouste-Orgeas M, Timsit JF; , for the Outcomerea Study Group.

Chest. 2007 Dec;132(6):1786-93. Epub 2007 Sep 21.

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Medical-Surgical ICU, Delafontaine Hospital, Saint Denis, France.

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 1692 patients with severe sepsis included in the Outcomerea database((R)) 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.