title: Outcomes in females hospitalised with community-acquired pneumonia are worse than in males.
abstract: There is little recent information on sex-specific outcomes of patients with community-acquired pneumonia (CAP). The objective of this study was to determine whether female sex is associated with better clinical outcomes in hospitalised patients with CAP. A secondary analysis was conducted by the Community Acquired Pneumonia Organization regarding male and female patients with CAP from 80 hospitals in 17 countries from June 1, 2001 to August 2, 2011. Outcomes were time to clinical stability, length of stay and in-hospital and 28-day mortality. Propensity-adjusted, multivariate regression models were used to predict the probability of occurrence of each of the study outcomes. There were 6718 patients in this study, of whom 40% were female. The adjusted hazard ratio (HR) for time to clinical stability was 0.91 (95% CI 0.85-0.97; p=0.005). The adjusted HR for length of stay was 0.94 (95% CI 0.88-1.01; p=0.089). The adjusted risk ratio for in-hospital mortality was 1.04 (95% CI 0.86-1.24; p=0.717), and for 28-day mortality was 1.15 (95% CI 1.02-1.30; p=0.018). This study demonstrates that the epidemiology of CAP may be changing, and that females have worse outcomes for CAP than males. They are more likely to take longer to reach clinical stability, have longer hospital stays and are 15% more likely to have died after 28 days. Current pneumonia scoring systems may need to be revised regarding female mortality risk.
authors: Division of Infectious Diseases, Dept of Medicine, School of Medicine, University of Louisville, Louisville, KY 40292, USA. F.Arnold@louisville.edu
authors: Forest W
authors: FW
authors: Arnold
authors: Timothy L
authors: TL
authors: Wiemken
authors: Paula
authors: P
authors: Peyrani
authors: Mehdi
authors: M
authors: Mirsaeidi
authors: Julio A
authors: JA
authors: Ramirez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007391:International Cooperation; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult