Adrie Christophe, Azoulay Elie, Francais Adrien, Clec'h Christophe, Darques Loic, Schwebel Carole, Nakache Didier, Jamali Samir, Goldgran-Toledano Dany, Garrouste-Orgeas Maïté, Timsit Jean François
Medical-Surgical ICU, Hôpital Delafontaine, 2, rue du Dr Delafontaine, 93205 Sant Denis, France.
Chest. 2007 Dec;132(6):1786-93. doi: 10.1378/chest.07-0420. Epub 2007 Sep 21.
The influence of gender on survival of patients with severe sepsis is unclear. Earlier studies suggested better survival in women, possibly related to the sex-steroid profile.
To investigate whether mortality from severe sepsis was higher in men than in women and whether the difference varied with menopausal status, we studied 1,692 patients with severe sepsis included in the OutcomeRea database over an 8-year period. We conducted a nested case-control study, accurately matching men and women on three criteria: a death propensity score, age, and center. Subgroup analyses were performed on individuals <or= 50 years old (men vs premenopausal women) and > 50 years old (men vs postmenopausal women).
We matched 1,000 men to 608 women with severe sepsis before and after adjustment for confounding factors (ie, chronic respiratory failure; metastatic cancer; immunocompromised status; emergency surgery, acute respiratory failure, and shock at admission; urinary tract infection; and type of microorganism). Overall hospital mortality was significantly lower in women (adjusted odds ratio [OR], 0.75; 95% confidence interval [CI], 0.57 to 0.97; p = 0.02). In the group > 50 years old (481 women, 778 men), hospital mortality was significantly lower in women (OR, 0.69; 95% CI, 0.52 to 0.93; p = 0.014). Hospital mortality was not significantly different between men and women in the younger group (127 women, 222 men) [OR, 1.01; 95% CI, 0.52 to 1.97; p = 0.98]. Level of care, as assessed using the nine equivalents of nursing manpower use score, was identical in men and women.
Among individuals > 50 years old with severe sepsis, women have a lower risk of hospital mortality than men.
性别对严重脓毒症患者生存率的影响尚不清楚。早期研究表明女性生存率更高，这可能与性类固醇谱有关。
为了调查严重脓毒症男性患者的死亡率是否高于女性，以及这种差异是否随绝经状态而变化，我们对OutcomeRea数据库中8年内纳入的1692例严重脓毒症患者进行了研究。我们进行了一项巢式病例对照研究，根据死亡倾向评分、年龄和中心这三个标准对男性和女性进行精确匹配。对年龄≤50岁（男性与绝经前女性）和>50岁（男性与绝经后女性）的个体进行亚组分析。
在对混杂因素（即慢性呼吸衰竭；转移性癌症；免疫功能低下状态；急诊手术、入院时急性呼吸衰竭和休克；尿路感染；以及微生物类型）进行调整前后，我们将1000例严重脓毒症男性患者与608例女性患者进行了匹配。女性的总体医院死亡率显著较低（调整后的优势比[OR]为0.75；95%置信区间[CI]为0.57至0.97；p = 0.
