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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://clinicaltrials.gov/ct2/show/NCT03370692.
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1 Paracelsus Medical University, Department of Cardiology, Salzburg, Austria (GRID:grid.21604.31) (ISNI:0000 0004 0523 5263); Karolinska University Hospital, Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705)
2 University Hospital, Department of Cardiology, Pulmonology and Angiology, Duesseldorf, Germany (GRID:grid.14778.3d) (ISNI:0000 0000 8922 7789)
3 Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France (GRID:grid.412370.3) (ISNI:0000 0004 1937 1100)
4 Department of Rehabilitation, Hospital Ancelle Di Cremona, Cremona, Italy (GRID:grid.412370.3); Geriatric Research Group, Brescia, Italy (GRID:grid.418194.1) (ISNI:0000 0004 1757 1678)
5 Ålesund Hospital, Department of Anaesthesia and Intensive Care, Ålesund, Norway (GRID:grid.459807.7); NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway (GRID:grid.5947.f) (ISNI:0000 0001 1516 2393)
6 Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Sabadell, Spain (GRID:grid.7080.f); University Hospitals Sagrado Corazón and General de Catalunya, Department of Intensive Care Medecine, Barcelona-Sant Cugat, Spain (GRID:grid.7080.f)
7 IRCCS Istituto Di Ricerche Farmacologiche “Mario Negri”, Dipartimento Di Epidemiologia Clinica, Ranica, Italy (GRID:grid.4527.4) (ISNI:0000000106678902)
8 Instituto Clínico Humanitas, Humanitas University, Department of Anaesthesia IRCCS, Milan, Italy (GRID:grid.417728.f) (ISNI:0000 0004 1756 8807)
9 Aarhus University Hospital, Department of Anaesthesia and Intensive Care Medicine, Aarhus, Denmark (GRID:grid.154185.c) (ISNI:0000 0004 0512 597X)
10 Grande Ospedale Metropolitano Niguarda, Milan, Italy (GRID:grid.154185.c)
11 Paracelsus Medical University, Department of Cardiology, Salzburg, Austria (GRID:grid.21604.31) (ISNI:0000 0004 0523 5263)
12 Misericordiae University Hospital, Dublin, Ireland (GRID:grid.14778.3d)
13 Unidade de Cuidados Intensivos Neurocríticos E Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Nova Médical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal (GRID:grid.414551.0) (ISNI:0000 0000 9715 2430)
14 Ghent University Hospital, Department of Intensive Care 1K12IC, Ghent, Belgium (GRID:grid.410566.0) (ISNI:0000 0004 0626 3303)
15 Karolinska University Hospital, Stockholm, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705)
16 Geneva University Hospitals, Geneva, Switzerland (GRID:grid.150338.c) (ISNI:0000 0001 0721 9812)
17 University Medical Center, University Utrecht, Department of Intensive Care Medicine, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000000090126352)
18 Jagiellonian University Medical College, Intensive Care and Perioperative Medicine Division, Kraków, Poland (GRID:grid.5522.0) (ISNI:0000 0001 2162 9631)
19 University Hospital Zurich, University of Zurich, Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland (GRID:grid.412004.3) (ISNI:0000 0004 0478 9977)
20 Kardinal Schwarzenberg Hospital, Schwarzach, Austria (GRID:grid.412004.3)
21 St George’s University Hospital, London, UK (GRID:grid.451349.e)
22 Research Lead Critical Care Directorate St George’s Hospital, London, UK (GRID:grid.464688.0) (ISNI:0000 0001 2300 7844)
23 Royal Devon & Exeter NHS Foundation Trust, NAHP Section ESICM,Intensive Care Unit, Exeter, UK (GRID:grid.419309.6) (ISNI:0000 0004 0495 6261)
24 Linkoping University Hospital, Linkoping, Sweden (GRID:grid.411384.b) (ISNI:0000 0000 9309 6304)
25 Inselspital, Bern University Hospital, Bern, Switzerland (GRID:grid.411656.1) (ISNI:0000 0004 0479 0855)
26 Medical University Innsbruck, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria (GRID:grid.5361.1) (ISNI:0000 0000 8853 2677)
27 European Wellness International, ICU, Luhansk, Ukraine (GRID:grid.5361.1)
28 Alkhums Hospital, ICU, Tripoli, Libya (GRID:grid.5361.1)
29 Aarhus University Hospital, Department of Intensive Care, Aarhus, Denmark (GRID:grid.154185.c) (ISNI:0000 0004 0512 597X)
30 Intensive Care Unit General Hospital of Larissa Tsakalof Larissa, Larissa, Greece (GRID:grid.154185.c)
31 Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France (GRID:grid.412370.3) (ISNI:0000 0004 1937 1100); Sorbonne Universités, Service de Réanimation, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Paris, France (GRID:grid.462844.8) (ISNI:0000 0001 2308 1657); INSERM, UMR_S 1136, Institut Pierre Louis D’Epidémiologie Et de Santé Publique, Paris, France (GRID:grid.7429.8) (ISNI:0000000121866389)
32 University of Bergen, Department of Clinical Medecine, Bergen, Norway (GRID:grid.7914.b) (ISNI:0000 0004 1936 7443); Haukeland University Hospital, Department of Anaestesia and Intensive Care, Bergen, Norway (GRID:grid.412008.f) (ISNI:0000 0000 9753 1393)