ObjectiveTo determine whether gender-related differences exist in the provided level of care and outcome in a large cohort of critically ill patients.DesignProspective, observational cohort study with data collection from January 1, 1998, to December 31, 2000.SettingThirty-one intensive care units in Austria.PatientsA total of 25,998 adult patients, consecutively admitted to 31 intensive care units in Austria..InterventionsWe assessed severity of illness, level of provided care, and vital status at hospital discharge.Measurements and Main ResultsOf 25,998 patients, 58.3% were male and 41.7% were female. Hospital mortality rate was slightly higher in women (18.1%) than in men (17.2%), but severity of illness-adjusted mortality rate was not different. Men received an overall increased level of care and had a significantly higher probability of receiving invasive procedures, such as mechanical ventilation (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.16–1.28), single vasoactive medication (OR, 1.18; 95% CI, 1.12–1.24), multiple vasoactive medication (OR, 1.21; 95% CI, 1.15–1.28), intravenous replacement of large fluid losses (OR, 1.14; 95% CI, 1.08–1.20), central venous catheter (OR, 1.06; 95% CI, 1.01–1.12), peripheral arterial catheter (OR, 1.15; 95% CI, 1.10–1.22), pulmonary artery catheter (OR, 1.48; 95% CI, 1.34–1.62), renal replacement therapy (OR, 1.28; 95% CI, 1.16–1.42), and intracranial pressure measurement (OR, 1.34; 95% CI, 1.18–1.53).ConclusionsIn a large cohort of critically ill patients, no differences in severity of illness-adjusted mortality rate between men and women were found. Despite a higher severity of illness in women, men received an increased level of care and underwent more invasive procedures. This different therapeutic approach in men did not translate into a better outcome.