title: Absence of gender-based differences in outcome of patients with hospital-acquired pneumonia.
abstract: BACKGROUND
  The objective of this analysis was to evaluate the association between gender and clinical outcomes in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) since data thus far are controversial.
  
  
  METHODS
  Data from a convenience sample of ICU patients with HAP, including ventilator-associated and health care-associated pneumonia, were retrospectively collected from four academic institutions (Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia [IMPACT-HAP] study). Outcomes included 28-day mortality, clinical failure at day 14, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. We compared baseline characteristics and performed multivariate analysis to identify factors independently associated with mortality.
  
  
  RESULTS
  Among 416 patients, 271 were men and 145 were women. Women were older (62.4±16.9 vs. 55.7±16.5 years, p<0.001) and more critically ill, with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 21 vs. 19 (p=0.004). Day-28 mortality was 30% for women and 24% for men (p=0.25). Increased 28-day mortality was associated with severity of illness, age, ventilator-associated pneumonia, vascular disease, and hospital LOS prior to pneumonia diagnosis. No significant differences were found in the distribution of bacteria pathogens or in clinical failure rates (36% vs. 31%) between genders. Duration in days of mechanical ventilation, ICU LOS and hospital LOS after the diagnosis of pneumonia were not significantly different between men and women. Analyzing data for women based on presumed pre- or postmenopausal status (age breakpoint of 50 years), showed an increased in ICU LOS (15 vs. 25 days; p=0.0026) and hospital LOS (22 vs. 30 days; p=0.05) for women ≤50 years. No differences were noted in 28-day mortality (24.3% vs. 13.1%; p=0.18) in women ≤50 years of age.
  
  
  CONCLUSIONS
  In ICU patients with pneumonia, female gender was not associated with worse outcomes or increased resource utilization compared to male gender. Further studies are needed to evaluate menopausal status and outcomes in women with pneumonia.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine , Jackson Memorial Hospital, Miami, Florida.
authors.forename: Fernando
authors.initials: F
authors.lastname: Caceres
authors.forename: Verna L
authors.initials: VL
authors.lastname: Welch
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kett
authors.forename: Ernesto G
authors.initials: EG
authors.lastname: Scerpella
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.forename: Kimbal D
authors.initials: KD
authors.lastname: Ford
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ramirez
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data*; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology