title: Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke.
abstract: OBJECTIVE
  Infectious complications after ischemic stroke are frequent and lead to neurological deterioration, poor functional outcomes, and higher mortality. Local and systemic inflammatory responses to brain ischemia differ between males and females, but little is known about differences in poststroke susceptibility to infection by sex. The purpose of this study was to compare sex-related differences in the risk of hospital-acquired sepsis and pneumonia after acute ischemic stroke (AIS).
  
  
  METHODS
  This is a retrospective, secondary analysis of the 2010-2011 California State Inpatient Database. Previously validated International Classification of Disease, Ninth Revision (ICD-9) codes were used to identify adult hospitalizations for AIS. The primary outcome was hospital-acquired sepsis or pneumonia, also identified using ICD-9 codes. Associations between sex and hospital-acquired sepsis or pneumonia were adjusted for baseline characteristics and comorbidities using multivariable logistic regression.
  
  
  RESULTS
  There were 91,643 hospitalizations for AIS included in this analysis, of which 1027 had hospital-acquired sepsis and 1225 had hospital-acquired pneumonia. The in-hospital mortality without infection was 4.6%; the presence of hospital-acquired infections was associated with higher mortality for sepsis (32.7%) and pneumonia (21.9%). Female (versus male) sex was associated with lower adjusted odds of hospital-acquired sepsis (odds ratio [OR] .74, 95% confidence interval [CI] .65-.84) and pneumonia (OR .69, 95% CI .62-.78). This difference was similar across age strata. Among hospitalizations with either hospital-acquired sepsis or pneumonia, sex did not influence mortality.
  
  
  CONCLUSIONS
  Female sex was associated with a lower risk of hospital-acquired sepsis and pneumonia after AIS. Further investigation is needed to determine the mechanisms underlying this clinical observation.
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: James F
authors.initials: JF
authors.lastname: Colbert
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Traystman
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: Sharon N
authors.initials: SN
authors.lastname: Poisson
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: Paco S
authors.initials: PS
authors.lastname: Herson
authors.affiliation: University of Colorado School of Medicine, Aurora, CO. Electronic address: adit.ginde@ucdenver.edu.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors
keywords: Ischemic stroke; epidemiology; pneumonia; sepsis; sex