Sex-based differences in ICU management and outcomes of immunocompromised patients: A post hoc analysis of the prospective multicenter multinational Efraim cohort.
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Mehta Sangeeta, Azoulay Elie, Munshi Laveena, Demoule Alexandre, Perner Anders, Meyhoff Tine Sylvest, Bauer Philippe R, Metaxa Victoria, Pène Frédéric, Girault Christophe, Soares Márcio, Taccone Fabio Silvio, Antonelli Massimo, Barbier Francois, Barratt-Due Andreas, Bruneel Fabrice, Bukan Ramin Brandt, Burghi Gastón, Chevret Sylvie, Gaborit Benjamin, Hemelaar Pleun, Kouatchet Achille, Landburg Precious Pearl, Lemiale Virginie, Martin-Loeches Ignacio, Mokart Djamel, Moreau Anne-Sophie, Montini Luca, Nielsen Lene Bjerregaard, Pickkers Peter, Rello Jordi, Rusinova Katerina, Salluh Jorge, Schellongowski Peter, Souppart Virginie, Terzi Nicolas, Valkonen Miia, van de Louw Andry, Darmon Michael, Efraim investigators and the Nine-I study group
Аннотация
METHODS: We performed a post hoc analysis of the Efraim study, a prospective multinational cohort study of immunocompromised adults with acute hypoxemic respiratory failure admitted to one of 68 ICU in 16 countries between November 2015 and July 2016. We compared in unadjusted and adjusted analyses baseline variables, ICU interventions, and outcomes between men and women.
RESULTS: We included 1536 immunocompromised adults (922 men, 614 women) in this study. Women and men had similar age, BMI, and diagnoses leading to immunosuppression; hematopoietic cell transplant was more common in men. On the first ICU day, SOFA score was higher in men vs. women (7 [IQR 4-10] vs 6 [4-10]), p = 0.0005). The use of ICU supportive interventions, including mechanical ventilation, vasopressors, renal replacement, bronchoalveolar lavage, and ARDS adjuncts, were similar between men and women; as were mortality in ICU, in hospital, and at 90 days. After adjustment, female sex (sub-hazard ratio 1.19, 95 % CI 1.05-1.36, p = 0.007), SOFA score on ICU day 1 (sHR 1.16, 95 % CI 1.12-1.19, p < 0.001) and chronic kidney disease (sHR 0.74, 95 % CI 0.59-0.93, p = 0.009) were associated with mechanical ventilation. Age, performance status and SOFA score on ICU day 1 were associated with hospital mortality.
CONCLUSIONS: In this post hoc analysis of immunocompromised adult ICU patients with hypoxemic respiratory failure, women and men received similar ICU interventions, and had similar outcomes.