Sex differences in long-term survival after intensive care unit treatment for sepsis: A cohort study

Kelly Thompson; Naomi Hammond; Michael Bailey; Jai Darvall; Gary Low; Steven McGloughlin; Lucy Modra; David Pilcher

doi:10.1371/journal.pone.0281939

Sex differences in long-term survival after intensive care unit treatment for sepsis: A cohort study

PLoS One. 2023 Feb 24;18(2):e0281939. doi: 10.1371/journal.pone.0281939. eCollection 2023.

Authors

Kelly Thompson^{1

2}, Naomi Hammond¹, Michael Bailey³, Jai Darvall^{4

5}, Gary Low^{1

2

6}, Steven McGloughlin^{3

7}, Lucy Modra^{4

8}, David Pilcher^{3

6

9}

Affiliations

¹ The George Institute for Global Health, UNSW Sydney, Newtown, NSW, Australia.
² Nepean and Blue Mountains Local Health District, Kingswood, NSW, Australia.
³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
⁴ Department of Critical Care, University of Melbourne, Melbourne, Australia.
⁵ Department of Intensive Care Medicine, Royal Melbourne Hospital, Melbourne, Australia.
⁶ Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁷ Department of Intensive Care, Alfred Health, Prahran, Melbourne, Australia.
⁸ Intensive Care Unit, Austin Health, Melbourne, Australia.
⁹ The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell Road, Camberwell, Melbourne, Australia.

Abstract

Objective: To determine the effect of sex on sepsis-related ICU admission and survival for up to 3-years.

Methods: Retrospective cohort study of adults admitted to Australian ICUs between 2018 and 2020. Men and women with a primary diagnosis of sepsis were included. The primary outcome of time to death for up to 3-years was examined using Kaplan Meier plots. Secondary outcomes included the duration of ICU and hospital stay.

Results: Of 523,576 admissions, there were 63,039 (12·0%) sepsis-related ICU admissions. Of these, there were 50,956 patients (43·4% women) with 3-year survival data. Men were older (mean age 66·5 vs 63·6 years), more commonly received mechanical ventilation (27·4% vs 24·7%) and renal replacement therapy (8·2% vs 6·8%) and had worse survival (Hazard Ratio [HR] 1·11; 95% Confidence Interval [CI] 1·07 to 1·14, P<0·001) compared to women. The duration of hospital and ICU stay was longer for men, compared to women (median hospital stay, 9.8 vs 9.4 days; p<0.001 and ICU stay, 2.7 vs 2.6 days; p<0.001).

Conclusion: Men are more likely to be admitted to ICU with sepsis and have worse survival for up to 3-years. Understanding causal mechanisms of sex differences may facilitate the development of targeted sepsis strategies.

Copyright: © 2023 Thompson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Australia
Cohort Studies
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Male
Retrospective Studies
Sepsis*
Sex Characteristics*

Grants and funding

KT received funding for the work from the National Health and Medical Research Council of Australia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.