Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

Bernhard Wernly, Raphael Romano Bruno, Malte Kelm, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Stefano Finazzi, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Michael Lichtenauer, Johanna M Muessig, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agvald Öhman, Bernado Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, David Niederseer, Andreas Valentin, Ximena Watson, Susannah Leaver, Carole Boulanger, Sten Walther, Joerg C Schefold, Michael Joannidis, Yuriy Nalapko, Muhammed Elhadi, Jesper Fjølner, Tilemachos Zafeiridis, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, Christian Jung, Bernhard Wernly, Raphael Romano Bruno, Malte Kelm, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Stefano Finazzi, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Michael Lichtenauer, Johanna M Muessig, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agvald Öhman, Bernado Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, David Niederseer, Andreas Valentin, Ximena Watson, Susannah Leaver, Carole Boulanger, Sten Walther, Joerg C Schefold, Michael Joannidis, Yuriy Nalapko, Muhammed Elhadi, Jesper Fjølner, Tilemachos Zafeiridis, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, Christian Jung

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 0.92-5.76%; 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://ichgcp.net/clinical-trials-registry/NCT03370692 .

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the propensity-score matching process.

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Source: PubMed

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