Aims: To explore differences between sexes in the prognosis of severe community-acquired pneumonia.

Methods: We analysed consecutive patients admitted to 27 intensive care units (ICU) from nine European countries and included in the EU-VAP/CAP cohort. All were mechanically ventilated for severe CAP. Sex was obtained from the medical records. Sexes were compared according to age, severity of illness, chronic health condition, co-morbidities, use of diagnostic procedures, length of mechanical ventilation, stay in the ICU, initial antibiotic treatment, and pathogens. The primary outcome was ICU mortality. We tested in a multivariate logistic regression the association of sex with mortality.

Results: We included 257 patients (32 % women; mean age 60.5 years). Mean SAPS II score was 48.6 and 125 patients (50.6 %) were in septic shock, without difference between sexes. Women had more frequently a McCabe score of 0 (61 % vs. 51 % of men, p = 0.13). Bronchoscopy was performed in 39 % of men and 26 % of women (p = 0.04). Antibiotic treatment did not differ between sexes. A pathogen was identified in 47 % of patients. 101 patients (39.3 %) died: 35 % of men and 48 % of women (OR 0.59, 95 % CI 0.34-1.00). Male sex was associated with lower mortality (OR 0.42, 95 % CI 0.21-0.84) after adjusting for age, SAPS II score, McCabe score, and use of bronchoscopy.

Conclusion: Women mechanically ventilated at the ICU for severe CAP had higher mortality despite similar severity of disease and better chronic health. Bronchoscopy was performed more frequently in men suggesting differences in management between sexes.