Sex-related disparities in sepsis in western Europe: A systematic review and meta-analysis.
Hagar L Mowafy, Nicolas Garin, Antonios Katsounas et al.
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In 30 seconds
This systematic review and meta-analysis examined sex-stratified mortality and infection patterns among adults with sepsis in Western Europe. It included 18 studies with 671,861 participants. Pooled short-term mortality odds were slightly lower in males than females (pooled OR = 0.96, 95% CI 0.94-0.98; low certainty), while analyses of hazard ratios suggested higher risk in males (pooled HR = 1.39, 95% CI 1.14-1.70; very-low certainty). No sex difference was identified for 90-day mortality. The authors conclude that sex alone is not a robust independent predictor of short-term mortality.
Key findings
- Short-term mortality odds were lower in males than females (pooled OR = 0.96, 95% CI 0.94-0.98; low certainty).
- Studies reporting hazard ratios found higher risk in males (pooled HR = 1.39, 95% CI 1.14-1.70; very-low certainty).
- For 90-day mortality, no difference was identified (HR = 1.00, 95% CI 0.92-1.08; low certainty).
- Pneumonia was more frequent among men, whereas urinary tract infections predominated in women.
Why it matters
The differing mortality estimates across analyses, alongside low or very low certainty, caution against treating sex as a standalone prognostic marker in sepsis. The observed differences in infection sites and the reported modifying roles of age and infection site support interpreting sex in clinical context rather than using it as a determinant of prognosis.
What to keep in mind
The evidence was drawn from observational studies, and certainty was low for short-term and 90-day mortality and very low for the hazard-ratio analysis. The review was limited to adult sepsis studies from Western Europe.