Gender-based differences in outcome in patients with sepsis

S R Eachempati, L Hydo, P S Barie
Archives of Surgery 1999, 134 (12): 1342-7

HYPOTHESIS: Among factors postulated to affect outcome in sepsis is the gender of the patient, with a suggestion that females may have lower mortality. This study tested the hypothesis that female patients admitted to the surgical intensive care unit with a documented infection have a lower mortality rate.

DESIGN: Retrospective analysis of a prospectively collected data set.

SETTING: Surgical intensive care unit of a university hospital medical center.

METHODS: Analysis of a consecutive series of 1348 patients who had signs of systemic inflammatory response syndrome on admission to a surgical intensive care unit. A cohort of 443 patients (32.9%) admitted with documented infection--and who therefore had sepsis, severe sepsis, or septic shock--constituted the study population. For each patient, APACHE (Acute Physiology and Chronic Health Evaluation) II and III scores, systemic inflammatory response syndrome score, gender, age, and hospital mortality were recorded. Chi2 With Fisher exact test was performed to compare mortality rates between males and females. Univariate analysis of variance was used to compare continuous variables in discrete populations. Multivariate analysis of variance was used to determine which factors independently predicted mortality.

PRIMARY OUTCOME MEASURES: Mortality, intensive care unit length of stay, hospital length of stay, and maximal multiple organ dysfunction score. Outcomes stratified by gender.

RESULTS: Patients had mean +/- SEM age of 67+/-1 years; mean +/- SEM APACHE II and III scores of 20.1+/-0.4 and 67.7+/-1.0 points, respectively. There were no demographic differences between genders. Overall, 104 (23.5%) of 443 patients with sepsis died. The difference in mortality rates between female and male patients was not significant, except in octogenarians (P = .05). Multivariate analysis of variance, APACHE III (P<.001), maximal multiple organ dysfunction score (P<.001), and female gender (P =.02) predicted mortality. In females, APACHE III (P = .03) and maximal multiple organ dysfunction score (P<.001) predicted mortality, but age did not.

CONCLUSION: Female gender is an independent predictor of increased mortality in critically ill surgical patients with documented infection.

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