Sex-related disparities in sepsis in western Europe: A systematic review and meta-analysis

Whether biological sex independently influences sepsis outcomes remains uncertain and historical data show heterogeneous findings.

We conducted this systematic review and meta-analysis according to PRISMA guidelines. PubMed, Scopus, and Web of Science were searched (January 2020 to April 2025) for studies reporting mortality outcomes in adult sepsis patients stratified by sex in Western Europe. We assessed studies' quality using the QUIPS tool. Report followed the Sex and Gender Equity in Research (SAGER) guidelines.

From 3445 records, 18 studies comprising 671,861 participants were included. Pneumonia was the most common infection in both sexes-significantly more frequent among men-whereas urinary tract infections predominated in women. Men consistently exhibited higher baseline severity scores, but the difference was not statistically significant. The pooled analysis showed a significant lower odds ratio (OR) of short-term mortality in males compared with females (pooled OR = 0.96, 95% CI 0.94-0.98; low certainty); this difference was consistent in sensitivity analyses restricted to low-bias studies. In contrast, meta-analysis of studies reporting hazard ratios (HR) indicated a higher risk in males (pooled HR = 1.39, 95% CI 1.14-1.70; very-low certainty), although no difference was identified for 90-day mortality (HR = 1.00, 95% CI 0.92-1.08; low certainty).

In contemporary Western Europe, sex alone is not a robust independent predictor of short-term sepsis mortality. Distinct sex-related patterns of infectious sites were identified. Age and infection sites modify the association, underscoring the need for sex-aware but not sex-determined prognostic assessment.