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

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

doi:10.1038/s41598-020-74910-3

Cited by 12 publications

(15 citation statements)

References 32 publications

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“…Three studies recorded limitation of life-sustaining treatment (LLST) at ICU admission, there was no statistically significant difference in the prevalence of LLST among women and men in these studies (20,23,31). No study recorded decisions to withhold or withdraw specific treatments such as MV or RRT.…”

Section: Characteristics Of Study Participantsmentioning

confidence: 99%

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Modra

Higgins

Abeygunawardana

et al. 2022

Critical Care Medicine

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To evaluate and synthesize the available literature on sex differences in the treatment of adult ICU patients. DATA SOURCES: MEDLINE and EMBASE.STUDY SELECTION: Two reviewers independently screened publications to identify observational studies of adult ICU patients that explicitly examined the association between sex and ICU treatment-specifically, mechanical ventilation, renal replacement therapy, and length of stay. DATA EXTRACTION:We extracted data independently and in duplicate: mean age, illness severity, use of mechanical ventilation and renal replacement therapy, and length of stay in ICU and hospital. We assessed risk of bias using the Newcastle-Ottawa Scale. We used a DerSimonian-Laird random-effects model to calculate pooled odds ratios (ORs) and mean differences between women and men. DATA SYNTHESIS:We screened 4,098 publications, identifying 21 eligible studies with 545,538 participants (42.7% women). The study populations ranged from 246 to 261,255 participants (median 4,420). Most studies (76.2%) were at high risk of bias in at least one domain, most commonly representativeness or comparability. Women were less likely than men to receive invasive mechanical ventilation (OR, 0.83; 95% CI, 0.77-0.89; I 2 = 90.4%) or renal replacement therapy (OR, 0.79; 95% CI, 0.70-0.90; I 2 = 76.2%). ICU length of stay was shorter in women than men (mean difference, -0.24 d; 95% CI, -0.37 to -0.12; I 2 = 89.9%). These findings persisted in meta-analysis of data adjusted for illness severity and other confounders and also in sensitivity analysis excluding studies at high risk of bias. There was no significant sex difference in duration of mechanical ventilation or hospital length of stay. CONCLUSIONS:Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses.

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Section: Characteristics Of Study Participantsmentioning

confidence: 99%

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Modra

Higgins

Abeygunawardana

et al. 2022

Critical Care Medicine

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“…In very old patients, mortality was higher in female patients and in those who did not receive mechanical ventilation or vasopressors. We are aware of the limitations of subgroup analyses (44), and we demonstrated recently that there were no clinically relevant differences between the sexes in septic patients (45,46). However, the trend toward a higher mortality in patients that did not receive intubation or vasopressors could reflect a more restrictive use of this therapy in very old patients.…”

Section: Discussionmentioning

confidence: 97%

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

Bruno

Wernly²,

Mamandipoor³

et al. 2021

Front. Med.

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Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.

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“…We conduct the disproportionality estimation [67, 76] on each adverse event to examine the association between the adverse event and pandemic (March 11–September 30, 2020) in contrast to before the pandemic (March 11–September 30, 2019). While disproportionality analysis is an established approach for pharmacovigilance to generate hypotheses on possible causal relations between drugs and adverse effects [72, 77], we here use it in a novel way that quantifying the association between adverse events and their submission periods.…”

Section: Methodsmentioning

confidence: 99%

“…Step 1) Disproportionality estimation. We conduct the disproportionality estimation [67,76] on each adverse event to examine the association between the adverse event and pandemic (March 11-September 30, 2020) in contrast to before the pandemic (March 11-September 30, 2019).…”

Section: Population-scale Adverse Event Model Of Patient Safetymentioning

confidence: 99%

Population-scale patient safety data reveal inequalities in adverse events before and during COVID-19 pandemic

Zhang

Sumathipala

Žitnik

2021

Preprint

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Adverse patient safety events were associated with 110 thousand deaths in the U.S. alone in 2019. The COVID-19 pandemic has further challenged the ability of healthcare systems to ensure medication safety, and its effects on patient safety remain unknown. Here, we investigate negative outcomes associated with medication use before and during the pandemic. Using a dataset of 10,443,476 reports involving 3,624 drugs and 19,193 adverse events, we develop an algorithmic approach to analyze the pandemic’s impact on incidence of drug safety events by evaluating disproportional reporting relative to the pre-pandemic time, quantifying unexpected trends in clinical outcomes, and adjusting for drug interference. Among 64 adverse events identified by our analyses, we find 54 have increased incidence rates during the pandemic, even though reporting of adverse events has decreased by 4.4% overall. We find clinically relevant differences in drug safety outcomes between demographic groups. Comparing to male patients, women report 47.0% more distinct adverse events whose occurrence significantly increased during the pandemic relative to pre-pandemic levels. Out of 53 adverse events with the pre-pandemic gender gap, 33 have increased gap during the pandemic more than would have been expected had the pandemic not occurred. While musculoskeletal and metabolic side effects are disproportionately enriched in women during the pandemic, immune-related adverse events are enriched only in men. We also find the number of adverse events with a higher reporting ratio during the pandemic in adults is higher (16.8%) than in older patients (adjusted for population size). Our findings have implications for safe medication use and public health policy and highlight the role of variation in adverse events for improving patient safety during a public health emergency.

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

Cited by 12 publications

References 32 publications

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

Population-scale patient safety data reveal inequalities in adverse events before and during COVID-19 pandemic

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