Gender differences in septic intensive care unit patients

INTRODUCTION: The world population is mostly male at birth, although there is a shift in predominance over 55 years of age with more females than males. Male gender was recently hypothesized to be a risk factor for sepsis and septic shock; the reasons and the consequences of this odd discrepancy are yet a matter of debate. We investigated the percentage of males and females in a large number of trials performed on septic adult patients admitted to Intensive Care Units. EVIDENCE ACQUISITION: We analyzed all the multicenter randomized controlled trials ever published in peer-reviewed Journals reporting a significant effect on mortality in intensive care unit septic adult patients; furthermore, we retrieved all the manuscripts dealing with sepsis or septic shock patients published in the last 3 years in the three medical Journals with the highest impact factor. EVIDENCE SYNTHESIS: We analyzed data from 12 multicenter randomized controlled trials (for a total of 5080 patients, 61% males) and from further 22 trials published in the New England Journal of Medicine, the Lancet, and the Journal of the American Medical Association (for a total of 493,066 patients, 54% males). Data on gender ratio in survivors were not available. CONCLUSIONS: Data from 34 large studies on 498,146 septic adult patients clearly showed a prevalence of males despite the expected female predominance. Further studies are required to explain the reasons, to evaluate if a difference is present in survival rate, and to identify gender-tailored preventive measures and treatments.