TY - JOUR
T1 - Sex-specific outcome disparities in very old patients admitted to intensive care medicine
T2 - a propensity matched analysis
AU - Wernly, Bernhard
AU - Bruno, Raphael Romano
AU - Kelm, Malte
AU - Boumendil, Ariane
AU - Morandi, Alessandro
AU - Andersen, Finn H
AU - Artigas, Antonio
AU - Finazzi, Stefano
AU - Cecconi, Maurizio
AU - Christensen, Steffen
AU - Faraldi, Loredana
AU - Lichtenauer, Michael
AU - Muessig, Johanna M
AU - Marsh, Brian
AU - Moreno, Rui
AU - Oeyen, Sandra
AU - Öhman, Christina Agvald
AU - Pinto, Bernado Bollen
AU - Soliman, Ivo W
AU - Szczeklik, Wojciech
AU - Niederseer, David
AU - Valentin, Andreas
AU - Watson, Ximena
AU - Leaver, Susannah
AU - Boulanger, Carole
AU - Walther, Sten
AU - Schefold, Joerg C
AU - Joannidis, Michael
AU - Nalapko, Yuriy
AU - Elhadi, Muhammed
AU - Fjølner, Jesper
AU - Zafeiridis, Tilemachos
AU - De Lange, Dylan W
AU - Guidet, Bertrand
AU - Flaatten, Hans
AU - Jung, Christian
PY - 2020/10/29
Y1 - 2020/10/29
N2 - 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 0.92-5.76%; p = 0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03-1.27; p = 0.007) and propensity score 2 (aOR 1.15 95%CI 1.04-1.27; 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 0.98-1.19; 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 .
AB - 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 0.92-5.76%; p = 0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03-1.27; p = 0.007) and propensity score 2 (aOR 1.15 95%CI 1.04-1.27; 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 0.98-1.19; 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 .
U2 - 10.1038/s41598-020-74910-3
DO - 10.1038/s41598-020-74910-3
M3 - Article
C2 - 33122713
VL - 10
JO - Scientific Reports
JF - Scientific Reports
SN - 2045-2322
IS - 1
M1 - 18671
ER -