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Christophe Adrie, MD; Carole Schwebel, MD; Jean-Francois Timsit, MD
Author and Funding Information

Affiliations: Delafontaine Hospital Saint Denis, France,  Albert Micahllon University Hospital Grenoble, France

Correspondence to: Christophe Adrie, MD, Service de Réanimation Polyvalente, Hôpital Delafontaine, 2, rue du Dr Delafontaine, 93205 Sant Denis, France; e-mail: christophe.adrie@outcomerea.org


OUTCOMEREA is supported by nonexclusive educational grants from Aventis Pharma, France; and Wyeth; as well as by public funds from the Centre National de la Recherche Scientifique (CNRS).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(3):671-672. doi:10.1378/chest.08-1434
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To the Editor:

First, we would like to thank the authors for their interest in our article.1 They raised a very interesting issue about a potential gender difference in an early time to initiation of an appropriate antimicrobial therapy that is known to be a crucial therapeutic strategy for improving survival in patients with severe sepsis. Conversely to the results of a previous Austrian study,2 we did not find any difference in the level of care between the sexes. However, we do agree that this particular issue could have been a potential confounder in our recently published article.1 Among the 1,608 men and women matched using our propensity score, 891 patients were appropriately treated right at the day of diagnosis (55%). Among them, 544 were men (54%) and 347 were women (57%). After conditional regression logistic analysis, early and appropriate antibiotherapy rate was not different between men and women (odds ratio, 1.12; 95% confidence interval, 0.91 to 1.38; p = 0.28). This clearly shows that early and appropriate therapy is not a confounder in our study and does not modify our message.

Adrie C, Azoulay E, Francais A, et al. Influence of gender on the outcome of severe sepsis: a reappraisal. Chest. 2007;132:1786-1793. [PubMed] [CrossRef]
 
Valentin A, Jordan B, Lang T, et al. Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med. 2003;31:1901-1907. [PubMed]
 

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Adrie C, Azoulay E, Francais A, et al. Influence of gender on the outcome of severe sepsis: a reappraisal. Chest. 2007;132:1786-1793. [PubMed] [CrossRef]
 
Valentin A, Jordan B, Lang T, et al. Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med. 2003;31:1901-1907. [PubMed]
 
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