O'Brien Joseph, Schrock Jon W
Cleveland Clinic Lerner College of Medicine, Department of Emergency Medicine, Cleveland, Ohio.
MetroHealth Medical Center, Department of Emergency Medicine, Cleveland, Ohio.
West J Emerg Med. 2025 Jul 11;26(4):880-887. doi: 10.5811/westjem.40005.
Sepsis is a common presentation to the emergency department (ED) and represents a life-threatening syndrome with high mortality rates. The existing literature has conflicting findings regarding outcomes between sexes. Our goal in this study was to investigate the clinical presentation, interventions, and outcomes based on sex for sepsis in the ED.
We conducted a retrospective cohort study to identify patients presenting with sepsis to the ED. We employed the Global Collaborative Network from 119 international healthcare organizations in the TriNetX Research Network. Sepsis was defined according to International Classification of Diseases, 10 Rev, codes. To evaluate sex differences in sepsis presentation, we collected data on age, comorbidities, sex, vital signs, laboratory values, medications, intensive care unit (ICU) admission, mechanical ventilation, and mortality at 30 days, 90 days, and one year. We used a 1:1 propensity score matching by age, race, comorbidities, and infection source to identify and balance potential risk factors across the study groups to investigate mortality, interventions, and intensive care unit admission trends. Data abstraction and analysis were conducted in the TriNetX platform.
In total, 920,160 patients were included in this study. The most common infection source for both females and males was respiratory, accounting for 40% and 46.2% of sepsis cases, respectively. After adjusting for urinary tract infection as an infection source, females were less likely to receive piperacillin-tazobactam (21% vs 23.6%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.75 - 0.77), vancomycin (32.9% vs 36%; OR, 0.87; 95% CI 0.86 - 0.88), and vasopressors (16.5% vs 17.6%; OR, 0.92; 95% CI 0.91 - 0.93). Females had a lower all-cause mortality at 30 days (12.1% vs 13%; OR 0.91; 95% CI 0.90 - 0.92), 90 days (17.1% vs 18.7%; OR 0.91; 95% CI 0.90 - 0.92), and one year (21.5% vs 23.3%; OR 0.90; 95% CI 0.89 - 0.91).
Females demonstrated 10% lower odds of mortality from sepsis at 30 days, 90 days, and one year (absolute difference: 0.9%, 1.6%, 1.8%, respectively). Females were less likely to receive vasopressors, vancomycin, or piperacillin-tazobactam, even after accounting for urinary tract infection as the sepsis source.
脓毒症是急诊科常见病症，是一种死亡率很高的危及生命的综合征。现有文献关于性别与预后的研究结果相互矛盾。本研究的目的是调查急诊科中基于性别的脓毒症临床表现、干预措施及预后情况。
我们开展了一项回顾性队列研究，以确定在急诊科就诊的脓毒症患者。我们使用了TriNetX研究网络中119个国际医疗组织的全球合作网络。脓毒症根据《国际疾病分类》第10版编码进行定义。为评估脓毒症表现中的性别差异，我们收集了年龄、合并症、性别、生命体征、实验室检查值、用药情况、重症监护病房（ICU）收治情况、机械通气以及30天、90天和1年死亡率的数据。我们采用1:1倾向评分匹配法，根据年龄、种族、合并症和感染源来识别并平衡研究组间的潜在风险因素，以调查死亡率、干预措施及重症监护病房收治趋势。数据提取与分析在TriNetX平台上进行。
本研究共纳入920,160例患者。女性和男性最常见的感染源均为呼吸道，分别占脓毒症病例的40%和46.2%。在将尿路感染作为感染源进行校正后，女性接受哌拉西林-他唑巴坦治疗的可能性较小（21%对23.6%；比值比[OR]0.76；95%置信区间[CI]0.75 - 0.77），接受万古霉素治疗的可能性较小（32.9%对36%；OR 0.87；95% CI 0.86 - 0.88），接受血管活性药物治疗的可能性较小（16.5%对17.6%；OR 0.92；95% CI 0.91 - 0.93）。女性在30天（12.1%对13%；OR 0.91；95% CI 0.90 - 0.92）、90天（17.1%对18.7%；OR 0.91；9% CI 0.90 - 0.92）和1年（21.5%对23.3%；OR 0.90；95% CI 0.89 - 0.91）时的全因死亡率较低。
女性在30天、90天和1年时脓毒症死亡几率低10%（绝对差异分别为0.9%、1.6%、1.8%）。即使将尿路感染作为脓毒症来源进行考量，女性接受血管活性药物、万古霉素或哌拉西林-他唑巴坦治疗的可能性仍较小。
