Sex differences in in-hospital management in patients with sepsis and septic shock: a prospective multicenter observational study

Sejoong Ahn, Bo Yeong Jin, Sukyo Lee, Sungjin Kim, Sungwoo Moon, Hanjin Cho, Kap Su Han, You Hwan Jo, Kyuseok Kim, Jonghwan Shin, Gil Joon Suh, Woon Yong Kwon, Tae Gun Shin, Han Sung Choi, Sangchun Choi, Yoo Seok Park, Sung Phil Chung, Won Young Kim, Hong Joon Ahn, Tae Ho LimSung Hyuk Choi, Jong Hak Park, Sang Min Kim, Seung Mok Ryoo, Gun Tak Lee, Sung Yeon Hwang, Byuk Sung Ko, Sung Joon Park, Jin Ho Beom, Taegyun Kim, Yoon Sun Jung, Juhyun Song, Taeyoung Kong, Eunah Han, Ji Eun Hwang, Hui Jai Lee, Gu Hyun Kang, Kihwan Choi, Ki Young Jeong, Seok Hun Ko, Hyo Jin Bang, Jinwoo Jeoung, Min Joon Seo, Sangsoo Han, Heewon Yang, Chiwon Ahn, Changsun Kim, Hyungoo Shin

Research output: Contribution to journalArticlepeer-review

Abstract

Sex differences in the in-hospital management of sepsis exist. Previous studies either included patients with sepsis that was defined using previous definitions of sepsis or evaluated the 3-h bundle therapy. Therefore, this study sought to assess sex differences in 1-h bundle therapy and in-hospital management among patients with sepsis and septic shock, defined according to the Sepsis-3 definitions. This observational study used data from Korean Shock Society (KoSS) registry, a prospective multicenter sepsis registry. Adult patients with sepsis between June 2018 and December 2021 were included in this study. The primary outcome was adherence to 1-h bundle therapy. Propensity score matching (PSM) and multivariable logistic regression analyses were performed. Among 3264 patients with sepsis, 3129 were analyzed. PSM yielded 2380 matched patients (1190 men and 1190 women). After PSM, 1-h bundle therapy was performed less frequently in women than in men (13.0% vs. 19.2%; p < 0.001). Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently in women than in men (25.4% vs. 31.6%, p < 0.001), whereas adequate fluid resuscitation was performed more frequently in women than in men (96.8% vs. 95.0%, p = 0.029). In multivariable logistic regression analysis, 1-h bundle therapy was performed less frequently in women than in men [adjusted odds ratio (aOR) 1.559; 95% confidence interval (CI) 1.245–1.951; p < 0.001] after adjustment. Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently to women than men (aOR 1.339, 95% CI 1.118–1.605; p = 0.002), whereas adequate fluid resuscitation was performed more frequently for women than for men (aOR 0.629, 95% CI 0.413–0.959; p = 0.031). Invasive arterial blood pressure monitoring was performed less frequently in women than in men. Resuscitation fluid, vasopressor, steroid, central-line insertion, ICU admission, length of stay in the emergency department, mechanical ventilator use, and renal replacement therapy use were comparable for both the sexes. Among patients with sepsis and septic shock, 1-h bundle therapy was performed less frequently in women than in men. Continuous efforts are required to increase adherence to the 1-h bundle therapy and to decrease sex differences in the in-hospital management of patients with sepsis and septic shock.

Original languageEnglish
Article number4900
JournalScientific Reports
Volume14
Issue number1
DOIs
Publication statusPublished - Feb 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Keywords

  • Antibiotics
  • Disparities
  • Emergency department
  • Fluid
  • Sepsis
  • Septic shock

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