Sex-based differences in sepsis-related complications and mortality among hospitalized patients with Myelodysplastic Syndromes: A national inpatient sample analysis (2016–2022)

Abstract Background: Patients with myelodysplastic syndromes (MDS) are highly susceptible to infections, with sepsis being a major cause of hospitalization and death. While gender differences in sepsis outcomes have been described in broader populations, their impact among patients with MDS remains poorly defined. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2022 to identify adult hospitalizations with co-diagnoses of MDS and sepsis. Patients were stratified by sex: male (n = 47,170) and female (n = 31,365). Multivariable logistic regression was used to evaluate the association between female sex and key outcomes: respiratory failure, encephalopathy, disseminated intravascular coagulation (DIC), Clostridioides difficile infection (CDI), fungal sepsis, and in-hospital mortality. Models were adjusted for demographics, comorbidities, and hospital characteristics. Results: Female sex was independently associated with increased odds of respiratory failure (OR 1.05, 95% CI 1.01–1.08, p = 0.011) and encephalopathy (OR 1.07, 95% CI 1.02–1.12, p = 0.010). There was a nonsignificant trend toward higher odds of CDI (OR 1.14, p = 0.086). No significant sex-based differences were observed for DIC (OR 0.84, p = 0.103), fungal sepsis (OR 0.89, p = 0.598), or in-hospital mortality (OR 0.98, p = 0.653). Conclusion: In this large national analysis of MDS patients hospitalized with sepsis, female patients were more likely to experience respiratory failure and encephalopathy, but sex was not significantly associated with mortality, DIC, or fungal infections. These findings suggest that while certain complications may differ by sex, overall in-hospital survival remains comparable between male and female patients with MDS and sepsis.Keywords: Myelodysplastic syndromes, sepsis, gender disparities, mortality, respiratory failure, encephalopathy, NIS