Sex differences in in-hospital management in patients with sepsis and septic shock: a prospective multicenter observational study
Authors: Ahn Sejoong , Jin Bo-Yeong , Lee Sukyo , Kim Sungjin , Moon Sungwoo , Cho Hanjin , Han Kap Su , Jo You Hwan , Kim Kyuseok , Shin Jonghwan , Suh Gil Joon , Kwon Woon Yong , Shin Tae Gun , Choi Han Sung , Choi Sangchun , Park Yoo Seok , Chung Sung Phil , Kim Won Young , Ahn Hong Joon , Lim Tae Ho , Choi Sung-Hyuk , Park Jong-Hak ,   Korean Shock Society (KoSS) Investigators, Kim Sang-Min , Ryoo Seung Mok , Lee Gun Tak , Hwang Sung Yeon , Ko Byuk Sung , Park Sung-Joon , Beom Jin Ho , Kim Taegyun , Jung Yoon Sun , Song Juhyun , Kong Taeyoung , Han Eunah , Hwang Ji Eun , Lee Hui Jai , Kang Gu Hyun , Choi Kihwan , Jeong Ki Young , Ko Seok Hun , Bang Hyo Jin , Jeoung Jinwoo , Seo Min Joon , Han Sangsoo , Yang Heewon , Ahn Chiwon , Kim Changsun , Shin Hyungoo 
Published: February 2024

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.