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Sex-Specific Outcome Disparities in Very Old Patients Admitted to Intensive Care Medicine: A Propensity Matched Analysis
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Edité par CCSD ; Nature Publishing Group -
International audience. 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 .
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