SEX DIFFERENCES IN SEPSIS-RELATED ACUTE RESPIRATORY DISTRESS SYNDROME AND OTHER SHORT-TERM OUTCOMES AMONG CRITICALLY ILL PATIENTS WITH SEPSIS: A RETROSPECTIVE STUDY IN CHINA.

Summary

In a 10-year, three-ICU retrospective cohort (n=2,111), male sex independently increased the odds of sepsis-related ARDS (aOR≈1.49–1.97 across analyses) and in-hospital mortality (aOR≈1.54). Findings persisted after multivariable adjustment, propensity matching, and sensitivity analysis.

Key Findings

• Male sex was independently associated with higher risk of sepsis-related ARDS (aOR 1.493 [1.034–2.156], P=0.032).
• Propensity-matched analysis showed 58% higher odds of ARDS in males (aOR 1.584 [1.022–2.456], P=0.040).
• Male sex increased in-hospital mortality (aOR 1.536 [1.087–2.169], P=0.015) and need for invasive mechanical ventilation (aOR 1.313 [1.029–1.674], P=0.028).
• Sensitivity analysis including postmenopausal women confirmed the association (aOR 1.968 [1.241–3.120], P=0.004).

Clinical Implications

Incorporate sex into ARDS risk models for sepsis, prioritize early detection and preventive measures in male patients, and consider sex-stratified analyses in future ARDS trials.

Limitations

• Retrospective design with potential residual confounding; single hospital system in China may limit generalizability.
• Lack of hormonal or immunophenotypic data to explain mechanisms of sex differences.

Future Directions

Validate sex-associated risk in multicenter prospective cohorts; integrate sex into ARDS prediction tools; explore biological mechanisms underpinning sex differences to inform targeted interventions.