Sex differences in trends and outcomes among patients with septic shock in the United States.

BACKGROUND

Despite substantial progress in early recognition and treatment, sepsis mortality rates continue to be high. The role of sociodemographic factors, such as sex, in outcomes among septic shock remains underexplored. We aimed to evaluate the trend and sex-specific outcomes in septic shock using a nationally representative database.

METHODS

A retrospective cohort study was conducted using the National Inpatient Sample (NIS) from 2016 to 2021. Adult patients (≥18 years) with septic shock were identified using ICD-10-CM codes. The primary outcome was in-hospital mortality. Multivariate logistic regression was used to adjust for demographic factors, hospital characteristics, and comorbidities.

RESULTS

Among 3504,269 hospitalizations, 52.7 % were men, with septic shock hospitalizations increasing significantly for both sexes over the study period. Men experienced higher in-hospital mortality (34.3 % vs. 32.8 %, p < 0.001) and AKI (69.0 % vs. 64.7 %, p < 0.001). Multivariate analysis revealed lower mortality odds in women than men (adjusted Odds Ratio 0.985, 95 % CI 0.975-0.996, p = 0.008), even after adjusting for comorbidities. Trends demonstrated a sharp increase in mortality beginning in 2020, coinciding with the COVID-19 pandemic.

CONCLUSIONS

Women with septic shock demonstrate lower odds of mortality and complications compared to men, highlighting potential protective factors or differences in clinical presentation. The sharp rise in mortality during the COVID-19 pandemic emphasizes the need for further research into the intersection of sex, race, and systemic factors affecting outcomes.