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Sex-specific outcomes and management in critically ill septic patients
Bernhard Wernly1, Raphael Romano Bruno2, Behrooz Mamandipoor3
1Paracelsus Medical University of Salzburg, Austria, Department of Cardiology, Clinic of Internal Medicine II, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Insights
This study found no significant sex-based differences in mortality for critically ill septic patients. While subtle gender-related factors may exist, they do not appear to impact overall survival rates in severe sepsis.
Area of Science:
- Critical care medicine
- Sepsis research
- Sex-based differences in health
Background:
- Critically ill patients with sepsis may exhibit variations in risk factors, treatment approaches, and health outcomes between sexes.
- This study aimed to investigate potential sex-specific differences in baseline risk distribution and outcomes among a large cohort of septic patients.
Purpose of the Study:
- To compare male versus female critically ill septic patients regarding baseline risk distribution and outcomes.
- To identify any sex-specific differences in intensive care unit (ICU) mortality.
Main Methods:
- Analysis of a large cohort of 17,146 patients (51% male, 49% female).
- Primary endpoint: ICU mortality.
- Multilevel logistic regression analyses were employed to evaluate sex-specific differences, controlling for various factors.
Main Results:
- Female patients presented with lower SOFA scores and creatinine levels compared to males (p<0.001).
- Overall ICU mortality was 10% and showed no significant difference between sexes (p=0.34).
- Adjusted analyses and sensitivity analyses confirmed no major sex-specific differences in ICU mortality.
Conclusions:
- No clinically significant sex-specific differences in mortality were observed in critically ill septic patients.
- Subtle gender-related influences might exist but do not appear to be a major determinant of mortality in the acute phase of severe sepsis.
Background:
Female and male critically ill septic patients might differ with regards to risk distribution, management, and outcomes. We aimed to compare male versus female septic patients in a large collective with regards to baseline risk distribution and outcomes.
Methods:
In total, 17,146 patients were included in this analysis, 8781 (51%) male and 8365 (49%) female patients. The primary endpoint was ICU-mortality. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analyses were used to assess sex-specific differences.
Results:
Female patients had lower SOFA scores (5 ± 5 vs. 6 ± 6; p<0.001) and creatinine (1.20±1.35 vs. 1.40±1.54; p<0.001). In the total cohort, the ICU mortality was 10% and similar between female and male (10% vs. 10%; p = 0.34) patients. The ICU remained similar between sexes after adjustment in model-1 (aOR 1.05 95% CI 0.95-1.16; p = 0.34); model-2 (aOR 0.91 95% CI 0.79-1.05; p = 0.18) and model-3 (aOR 0.93 95% CI 0.80-1.07; p = 0.29). In sensitivity analyses, no major sex-specific differences in mortality could be detected.
Conclusion:
In this study no clinically relevant sex-specific mortality differences could be detected in critically ill septic patients. Possible subtle gender differences could play a minor role in the acute situation due to the severity of the disease in septic patients.
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