Gender differences in mortality in patients with severe sepsis or septic shock

Background: Although the incidence of sepsis is higher in men than in women, it is controversial whether there are sex-based differences in sepsis-associated mortality.

Objective: The aim of this study was to test the hypothesis that hospital mortality is higher in males compared with females with severe sepsis/septic shock who require intensive care.

Methods: This was a retrospective cohort study of intensive care unit (ICU) patients hospitalized (in 98 ICUs in 71 US hospitals and 4 Canadian or Brazilian hospitals) with severe sepsis/septic shock between mid-2003 and 2006, using data from the Cerner Project IMPACT database.

Results: Data were analyzed for 18,757 ICU patients (median age, 66 years; interquartile range, 53-77 years), including 8702 females (46%). Hospital mortality was higher in female patients compared with male patients (35% vs 33%, respectively; P = 0.006). After adjusting for differences in baseline characteristics and processes of care, females had a higher likelihood of hospital mortality than did males (odds ratio [OR] = 1.11; 95% CI, 1.04-1.19; P = 0.002). Female patients were less likely than male patients to receive deep venous thrombosis prophylaxis (OR = 0.90; 95% CI, 0.84-0.97), invasive mechanical ventilation (OR = 0.81; 95% CI, 0.76-0.86), or hemodialysis catheters (OR = 0.85; 95% CI, 0.78-0.93). Females were more likely than males to receive red blood cell transfusions (OR = 1.15; 95% CI, 1.09-1.22) and code status limitations (OR = 1.31; 95% CI, 1.18-1.47).

Conclusions: In this large cohort of ICU patients, females with severe sepsis/septic shock had a higher risk of dying in the hospital than did males. This difference remained after multivariable adjustment. Significant gender disparities were also found in some aspects of care delivery, but these did not explain the higher mortality in female patients.