Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 25:14:613-622.
doi: 10.2147/IJGM.S294229. eCollection 2021.

Sex Differences in Short- and Long-Term Survival Among Critically Ill Patients with Sepsis

Shan Lin #  1 , Wanmei He #  1 , Zixuan Hu  1 , Lihong Bai  1 , Mian Zeng  1
Affiliations

Sex Differences in Short- and Long-Term Survival Among Critically Ill Patients with Sepsis

Shan Lin et al. Int J Gen Med. .

Abstract

Background: Currently, there have been studies showing a correlation between sex differences and prognosis. Nevertheless, the conclusions of clinical studies on sex-based differences are controversial. We aimed to evaluate the effect of sex on the short- and long-term survival of critically ill patients with sepsis.

Methods: We use the critical care database of the healthcare information mart. Cox models were conducted to determine the relationship of 28-day and 1-year mortality with a different sex. Interaction and stratified analyses were conducted to test whether the effect of sex differed across age and sequential organ failure assessment (SOFA) score subgroups.

Results: A total of 12,321 patients were enrolled in this study. The Cox regression analysis showed that the 28-day and 1-year mortality rates of female patients were significantly lower than those of male patients by 10% and 8%, respectively (hazard ratio [HR]=0.90, 95% confidence interval [CI] 0.83-0.98, and HR=0.92, 95% CI 0.87-0.97, respectively). The effects of the association between sex and 28-day and 1-year mortality were broadly consistent for age and the SOFA subgroup variables. Only age was observed to have significant interactions in the 1-year mortality (P=0.0177). Compared with male patients, female patients aged <50 years had a long-term survival advantage (HR=0.77, 95% CI 0.62-0.95). In contrast, we did not find sex-based differences in the short- and long-term survival for patients aged ≥50 years.

Conclusion: In the current retrospective large database review, the 28-day and 1-year mortality were significantly lower in females than in male patients among critically ill patients with sepsis. Notably, there was an interaction between age and sex, and whether female-associated hormones or other contributing factors affect the clinical outcomes of patients with sepsis needs to be further researched.

Keywords: critical care; prognosis; sepsis; sex.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The 28-day survival curve of the Cox regression model for participants with age <50 years.
Figure 2
Figure 2
The 28-day survival curve of the Cox regression model for participants with age ≥50 years.
Figure 3
Figure 3
The 1-year survival curve of the Cox regression model for participants with age <50 years.
Figure 4
Figure 4
The 1-year survival curve of the Cox regression model for participants with age ≥50 years.
Figure 5
Figure 5
(A) Association of age with 28-day mortality in males and females. (B) Association of age with 1-year mortality in males and females.
Figure 6
Figure 6
(A) Association of SOFA groups with 28-day mortality in males and females. (B) Association of SOFA groups with 1-year mortality in males and females.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:801–810. doi:10.1001/jama.2016.0287 - DOI - PMC - PubMed
    1. Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012;40:754–761. doi:10.1097/CCM.0b013e318232db65 - DOI - PubMed
    1. Rhee C, Dantes R, Epstein L, et al.; CDC Prevention Epicenter Program. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA. 2017;318:1241–1249. doi:10.1001/jama.2017.13836 - DOI - PMC - PubMed
    1. Fleischmann C, Scherag A, Adhikari NK, et al.; International Forum of Acute Care Trialists. Assessment of global incidence and mortality of hospital-treated sepsis: current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–272. doi:10.1164/rccm.201504-0781OC - DOI - PubMed
    1. Zellweger R, Wichmann MW, Ayala A, Stein S, DeMaso CM, Chaudry IH. Females in proestrus state maintain splenic immune functions and tolerate sepsis better than males. Crit Care Med. 1997;25:106–110. doi:10.1097/00003246-199701000-00021 - DOI - PubMed

LinkOut - more resources