Influence of gender on the outcome of severe sepsis: a reappraisal.
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 <or= 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.
Adrie
Christophe
C
Medical-Surgical ICU, Hôpital Delafontaine, 2, rue du Dr Delafontaine, 93205 Sant Denis, France. christophe.adrie@outcomerea.org
Azoulay
Elie
E
Francais
Adrien
A
Clec'h
Christophe
C
Darques
Loic
L
Schwebel
Carole
C
Nakache
Didier
D
Jamali
Samir
S
Goldgran-Toledano
Dany
D
Garrouste-Orgeas
Maïté
M
Timsit
Jean François
JF
D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D004198:Disease Susceptibility; D005260:Female; D005602:France / Q000453:epidemiology; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000276:immunology* / Q000401:mortality*; D012737:Sex Factors
D012739:Gonadal Steroid Hormones