Sex-Specific Outcome Disparities in Very Old Patients Admitted to Intensive Care Medicine: a Propensity Matched Analysis

• Autor(a) principal: Wernly, B
• Data de Publicação: 2020
• Outros Autores: Romano Bruno, R, Kelm, M, Boumendil, A, Morandi, A, Andersen, F, Artigas, A, Finazzi, S, Cecconi, M, Christensen, S, Faraldi, L, Lichtenauer, M, Muessig, J, Marsh, B, Moreno, R, Oeyen, S, Öhman, C, Bollen Pinto, B, Soliman, I, Szczeklik, W, Niederseer, D, Valentin, A, Watson, X, Leaver, S, Boulanger, C, Walther, S, Schefold, J, Joannidis, M, Nalapko, Y, Elhadi, M, Fjølner, J, Zafeiridis, T, De Lange, D, Guidet, B, Flaatten, H, Jung, C
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/4809
• topic: HSJ UCI; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Male; Critical Care*; Patient Admission*; Propensity Score; Sex Factors*; Treatment Outcome*

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 .