Sex-Specific Outcome Disparities in Very Old Patients Admitted to Intensive Care Medicine: A Propensity Matched Analysis
Bernhard Wernly
(1)
,
Raphael Romano Bruno
(2)
,
Malte Kelm
(2)
,
Ariane Boumendil
(3)
,
Alessandro Morandi
,
Finn H. Andersen
,
Antonio Artigas
(4)
,
Stefano Finazzi
,
Maurizio Cecconi
,
Steffen Christensen
(5)
,
Loredana Faraldi
,
Michael Lichtenauer
(1)
,
Johanna M. Muessig
,
Brian Marsh
(6)
,
Rui Moreno
(7)
,
Sandra Oeyen
(8)
,
Christina Agvald Öhman
(9)
,
Bernado Bollen Pinto
,
Ivo W. Soliman
,
Wojciech Szczeklik
(10)
,
David Niederseer
,
Andreas Valentin
,
Ximena Watson
(11)
,
Susannah Leaver
(11)
,
Carole Boulanger
,
Sten Walther
(12)
,
Joerg C. Schefold
,
Michael Joannidis
(13)
,
Yuriy Nalapko
,
Muhammed Elhadi
,
Jesper Fjølner
(5)
,
Tilemachos Zafeiridis
(14)
,
Dylan W. de Lange
,
Bertrand Guidet
(3, 15)
,
Hans Flaatten
(16)
,
Christian Jung
(2)
1
PMU -
Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
2 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
3 CHU Saint-Antoine [AP-HP]
4 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
5 Aarhus University Hospital
6 The Mater Hospital - Mater Misericordiae University Hospital
7 Centro Hospitalar de Lisboa Central E.P.E
8 Ghent University Hospital
9 Karolinska University Hospital [Stockholm]
10 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
11 St George’s University Hospitals
12 Linköping university hospital
13 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
14 University Hospital of Larissa
15 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
16 UiB - University of Bergen
2 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
3 CHU Saint-Antoine [AP-HP]
4 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
5 Aarhus University Hospital
6 The Mater Hospital - Mater Misericordiae University Hospital
7 Centro Hospitalar de Lisboa Central E.P.E
8 Ghent University Hospital
9 Karolinska University Hospital [Stockholm]
10 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
11 St George’s University Hospitals
12 Linköping university hospital
13 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
14 University Hospital of Larissa
15 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
16 UiB - University of Bergen
Alessandro Morandi
- Fonction : Auteur
Finn H. Andersen
- Fonction : Auteur
Stefano Finazzi
- Fonction : Auteur
Maurizio Cecconi
- Fonction : Auteur
Loredana Faraldi
- Fonction : Auteur
Johanna M. Muessig
- Fonction : Auteur
Bernado Bollen Pinto
- Fonction : Auteur
Ivo W. Soliman
- Fonction : Auteur
David Niederseer
- Fonction : Auteur
Andreas Valentin
- Fonction : Auteur
Carole Boulanger
- Fonction : Auteur
Joerg C. Schefold
- Fonction : Auteur
Yuriy Nalapko
- Fonction : Auteur
Muhammed Elhadi
- Fonction : Auteur
Dylan W. de Lange
- Fonction : Auteur
Bertrand Guidet
- Fonction : Auteur
- PersonId : 988017
- IdHAL : bertrand-guidet
- ORCID : 0000-0002-7643-6770
- IdRef : 076134350
Résumé
Abstract Female and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The primary endpoint was 30-day-mortality. Baseline characteristics, data on management and geriatric scores including frailty assessed by Clinical Frailty Scale (CFS) were documented. Two propensity scores (for being male) were obtained for consecutive matching, score 1 for baseline characteristics and score 2 for baseline characteristics and ICU management. Male VIPs were younger (83\,±\,5 vs. 84\,±\,5; p \,<\,0.001), less often frail (CFS\,>\,4; 38% versus 49%; p \,<\,0.001) but evidenced higher SOFA (7\,±\,6 versus 6\,±\,6 points; p \,<\,0.001) scores. After propensity score matching, no differences in baseline characteristics could be observed. In the paired analysis, the mortality in male VIPs was higher (mean difference 3.34% 95%CI 0.92\textendash 5.76%; p \,=\,0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03\textendash 1.27; p \,=\,0.007) and propensity score 2 (aOR 1.15 95%CI 1.04\textendash 1.27; p \,=\,0.007) male sex was independently associated with higher odds for 30-day-mortality. Of note, male gender was not associated with ICU mortality (OR 1.08 95%CI 0.98\textendash 1.19; p \,=\,0.14). Outcomes of elderly intensive care patients evidenced independent sex differences. Male sex was associated with adverse 30-day-mortality but not ICU-mortality. Further research to identify potential sex-specific risk factors after ICU discharge is warranted. Trial registration : NCT03134807 and NCT03370692; Registered on May 1, 2017 https://clinicaltrials.gov/ct2/show/NCT03370692 .