Sepsis is a major public health priority. Sepsis-related diagnoses are life-threatening global health care conditions that may lead to organ failure, shock, and death. The rate of associated hospitalizations doubled from 2000 through 2008; sepsis was the leading cause of death in the United States in 2010 and was noted to be the single most expensive condition treated in hospitals in 2011 (Walkey, Lagu, & Lindenauer, 2015). Despite advances in the recognition and treatment of sepsis, mortality remains at 30%. By 2020, an estimated additional one million cases annually are projected to occur due to the aging population, increased invasive procedures, and comorbidities (Leedahl, Personett, Gajic, Kashyap, & Schramm, 2014). Predictors of survival for those with sepsis are inconclusive. Notably, clinical sepsis studies evaluating the influence of gender on survival are not clear (Jacobson, Liedgren, Johnsson, Ferm, & Winso, 2012; Madsen et al., 2014; Nachtigall et al., 2011). Contributors to disparities have been attributed to differences in clinical presentation and health care delivery (Soto et al., 2013). The purpose of this completed study was to identify factors including gender that affect survival for patients with a diagnosis of severe sepsis or septic shock.
Methods:
After Institutional Review Board approval, the study was conducted in a large metropolitan, non-profit, Magnet recognized, acute care hospital located in the Southwestern region of the United States. This study used a retrospective, descriptive correlational design. A sample of patients, 18 years or older presenting to the emergency department and who subsequently met the criteria for a discharge diagnosis of severe sepsis or septic shock as defined by the Surviving Sepsis Campaign provided data for this study (Society of Critical Care Medicine, 2015). Data on patient characteristics, clinical variables, care management processes, and outcomes were extracted from the electronic medical record and analyzed. Descriptive and inferential statistical analyses were performed using International Business Machines Statistical Package for the Social Sciences for Windows, Version 23.0.
Results:
Data were reviewed for all patients with a diagnosis of severe sepsis or septic shock and 482 patients met inclusion criteria: Males (248, 51.5%); Females (234, 48.5%). Exclusion criteria included patients who had previously selected end-of-life or palliative care measures upon admission. The mean age for all patients was 67.9 years (SD 16.5). The majority of patients were White (51%), with 16.6% Hispanic, 14.9% Asian, 5.8% Black, and 11.6% other. The majority of the patients were diagnosed with septic shock (62.2%) compared to severe sepsis (37.8%).
Logistic regression with eight independent variables included: (1) discharge diagnosis, (2) age, (3) comorbidities, (4) length of hospital stay, (5) source of infection, (6) first lactate level, (7) recommended fluids administered, and (8) gender. All independent variables reliably predicted which patients would survive χ2 (12, 423) = 118.39, p < .001 and correctly classified 77.3% of cases. All independent variables significantly contributed to the model, but the model revealed females had a higher likelihood of hospital mortality than males (OR = 1.68; 95% CI, 1.01-2.79; p < .05). Limitations of the study included potential selection bias since the study was observational and lacked a random sample of patients with severe sepsis or septic shock. Additionally, because all data were extracted from the electronic medical record, providers’ undocumented impressions of diagnosis, source of infection, and/or severity of illness may have affected care processes.
Conclusion:
The Surviving Sepsis Campaign has provided a clear path for patients with sepsis-related diagnoses including the need for early recognition and treatment interventions (Society of Critical Care Medicine, 2015). Previous studies have identified more rapid identification of patients at risk for sepsis through electronic medical record enhancements, sepsis response teams, and interprofessional education and simulation (Palleschi, Sirianni, O’Connor, Dunn, & Hasenau, 2014; Schramm, Kashyap, Mullon, Ognjen, & Afessa, 2011). Therapeutic strategies are needed to address gender differences and there are opportunities to address decision-making with regard to potential bias. New or revised policies may be established to safeguard against disparity between genders and educational efforts may be employed to build awareness surrounding the different illness presentations exhibited by females versus males. Aggressive applications of evidence-based interventions may result in better patient outcomes. The study findings have global implications for future studies in addressing if gender disparities exist in the use of validated sepsis therapies.
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