Influence of Gender on Age-associated In-hospital Mortality in Patients with Sepsis and Septic Shock: a Prospective Nationwide Multicenter Cohort Study

Overview

Journal Crit Care

Specialty Critical Care

Date 2023 Jun 11

PMID 37303037

Authors

Ryoung-Eun Ko

Danbee Kang

Juhee Cho

Soo Jin Na

Chi Ryang Chung

Sung Yoon Lim

Yeon Joo Lee

Sunghoon Park

Dong Kyu Oh

Su Yeon Lee

Mi Hyeon Park

Haein Lee

Chae-Man Lim

Gee Young Suh

Affiliations

Soon will be listed here.

Abstract

Background: Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have shown conflicting evidence. This study aimed to investigate the effect of gender on in-hospital mortality due to sepsis according to age group.

Methods: This study used data from the Korean Sepsis Alliance, an ongoing nationwide prospective multicenter cohort from 19 participating hospitals in South Korea. All adult patients diagnosed with sepsis in the emergency departments of the participating hospitals between September 2019 and December 2021 were included in the analysis. Clinical characteristics and outcomes were compared between male and female. Eligible patients were stratified by age into 19-50 years, 50-80 years, and ≥ 80 years old individuals.

Results: During the study period, 6442 patients were included in the analysis, and 3650 (56.7%) were male. The adjusted odds ratio (OR) [95% confidence interval (CI)] for in-hospital mortality for male compared with female was 1.15 (95% CI = 1.02-1.29). Interestingly, in the age 19-50 group, the risk of in-hospital mortality for males was significantly lower than that of females [0.57 (95% CI = 0.35-0.93)]. For female, the risk of death remained relatively stable until around age 80 (P for linearity = 0.77), while in males, there was a linear increase in the risk of in-hospital death until around age 80 (P for linearity < 0.01). Respiratory infection (53.8% vs. 37.4%, p < 0.01) was more common in male, whereas urinary tract infection (14.7% vs. 29.8%, p < 0.01) was more common in female. For respiratory infection, male had significantly lower in-hospital mortality than female in the age 19-50 groups (adjusted OR = 0.29, 95% CI = 0.12-0.69).

Conclusions: Gender may influence age-associated sepsis outcomes. Further studies are needed to replicate our findings and fully understand the interaction of gender and age on the outcomes of patients with sepsis.

Citing Articles

Potentials of Presepsin as a Novel Sepsis Biomarker in Critically Ill Adults: Correlation Analysis with the Current Diagnostic Markers.

Sater M, Almansour N, Malalla Z, Fredericks S, Ali M, Giha H Diagnostics (Basel). 2025; 15(2).

PMID: 39857101 PMC: 11763968. DOI: 10.3390/diagnostics15020217.

Influence of underlying condition and performance of sepsis bundle in very old patients with sepsis: a nationwide cohort study.

Kim D, Kim S, Kang D, Ju H, Oh D, Lee S Ann Intensive Care. 2024; 14(1):179.

PMID: 39630376 PMC: 11618279. DOI: 10.1186/s13613-024-01415-x.

Development of an iron status biomarker-based sepsis prognostic model using MIMIC-IV data.

Zha W, Ou Q, Zhang Y, Huang Q, Li J, Wen M World J Emerg Med. 2024; 15(6):494-498.

PMID: 39600817 PMC: 11586141. DOI: 10.5847/wjem.j.1920-8642.2024.087.

Epidemiology of sepsis-associated acute kidney injury in critically ill patients: a multicenter, prospective, observational cohort study in South Korea.

Song M, Jang Y, Legrand M, Park S, Ko R, Suh G Crit Care. 2024; 28(1):383.

PMID: 39581988 PMC: 11587587. DOI: 10.1186/s13054-024-05167-9.

Sex matters: Is it time for a SOFA makeover?.

Larsson E Crit Care. 2024; 28(1):268.

PMID: 39118159 PMC: 11312820. DOI: 10.1186/s13054-024-05030-x.

References

Leligdowicz A, Dodek P, Norena M, Wong H, Kumar A, Kumar A . Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med. 2014; 189(10):1204-13. DOI: 10.1164/rccm.201310-1875OC. View

Plante L, Pacheco L, Louis J . SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol. 2019; 220(4):B2-B10. DOI: 10.1016/j.ajog.2019.01.216. View

Adrie C, Azoulay E, Francais A, Clech C, Darques L, Schwebel C . Influence of gender on the outcome of severe sepsis: a reappraisal. Chest. 2007; 132(6):1786-93. DOI: 10.1378/chest.07-0420. View

Flaatten H, de Lange D, Morandi A, Andersen F, Artigas A, Bertolini G . The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017; 43(12):1820-1828. DOI: 10.1007/s00134-017-4940-8. View

Madsen T, Napoli A . The DISPARITY-II study: delays to antibiotic administration in women with severe sepsis or septic shock. Acad Emerg Med. 2014; 21(12):1499-502. DOI: 10.1111/acem.12546. View

Xu J, Tong L, Yao J, Guo Z, Lui K, Hu X . Association of Sex With Clinical Outcome in Critically Ill Sepsis Patients: A Retrospective Analysis of the Large Clinical Database MIMIC-III. Shock. 2018; 52(2):146-151. PMC: 6687414. DOI: 10.1097/SHK.0000000000001253. View

Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R . Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017; 43(3):304-377. DOI: 10.1007/s00134-017-4683-6. View

Stortz J, Cox M, Hawkins R, Ghita G, Brumback B, Mohr A . Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study. Crit Care. 2020; 24(1):203. PMC: 7206740. DOI: 10.1186/s13054-020-02917-3. View

van Vught L, Scicluna B, Wiewel M, Hoogendijk A, Klein Klouwenberg P, Ong D . Association of Gender With Outcome and Host Response in Critically Ill Sepsis Patients. Crit Care Med. 2017; 45(11):1854-1862. DOI: 10.1097/CCM.0000000000002649. View

10.

Bianchi V . The Anti-Inflammatory Effects of Testosterone. J Endocr Soc. 2018; 3(1):91-107. PMC: 6299269. DOI: 10.1210/js.2018-00186. View

11.

Iwashyna T, Wesley Ely E, Smith D, Langa K . Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010; 304(16):1787-94. PMC: 3345288. DOI: 10.1001/jama.2010.1553. View

12.

Prest J, Sathananthan M, Jeganathan N . Current Trends in Sepsis-Related Mortality in the United States. Crit Care Med. 2021; 49(8):1276-1284. DOI: 10.1097/CCM.0000000000005017. View

13.

Wichmann M, Inthorn D, Andress H, Schildberg F . Incidence and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome. Intensive Care Med. 2000; 26(2):167-72. DOI: 10.1007/s001340050041. View

14.

Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S . The influence of gender on the epidemiology of and outcome from severe sepsis. Crit Care. 2013; 17(2):R50. PMC: 3733421. DOI: 10.1186/cc12570. View

15.

Gauthier J, Wu Q, Gooley T . Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians. Bone Marrow Transplant. 2019; 55(4):675-680. DOI: 10.1038/s41409-019-0679-x. View

16.

Gold E . The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011; 38(3):425-40. PMC: 3285482. DOI: 10.1016/j.ogc.2011.05.002. View

17.

Papathanassoglou E, Middleton N, Benbenishty J, Williams G, Christofi M, Hegadoren K . Systematic review of gender- dependent outcomes in sepsis. Nurs Crit Care. 2017; 22(5):284-292. DOI: 10.1111/nicc.12280. View

18.

Luethi N, Bailey M, Higgins A, Howe B, Peake S, Delaney A . Gender differences in mortality and quality of life after septic shock: A post-hoc analysis of the ARISE study. J Crit Care. 2019; 55:177-183. DOI: 10.1016/j.jcrc.2019.11.002. View

19.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

20.

Blanco J, Muriel-Bombin A, Sagredo V, Taboada F, Gandia F, Tamayo L . Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care. 2008; 12(6):R158. PMC: 2646323. DOI: 10.1186/cc7157. View