Sex-specific differences in risk factors and outcomes for long-term mechanical ventilation: a longitudinal cohort analysis of claims data
Abstract
Abstract Sex differences in intensive care medicine, particularly regarding risk factors for (MV), are underexplored. This study aimed to investigate sex-related risk factors for long-term MV. We analyzed claims data from patients aged ≥ 30, with at least one comorbidity, who received MV (≥ 96 h) between 2015 and 2018. Data covered 365 days prior to hospitalization and 30 days post-discharge. Sex differences in 29 predefined risk factors were assessed. Over 12,000 hospitalizations were analyzed, with 37.8% of patients being female. Women were older (71.3 ± 11.6 vs. 69.9 ± 11.2 years, p < 0.001) and more often transferred from nursing homes (4.5% vs. 2.7%, p < 0.001). Men required invasive long-term ventilation more often (33.8% vs. 31.2%, p = 0.004) and had more ventilation hours (400.0 ± 377.9 vs. 373.0 ± 341.8, p < 0.001). Among pre-existing conditions, women had more thyroiditis and rheumatic mitral valve disease, while men had more COPD, cardiac arrhythmia, eating disorders, and acute pancreatitis. Men were more likely to undergo bronchoscopy, autologous blood transfusion, or Extracorporeal life support (ECLS) within 96 h of MV. Multivariate analyses revealed stronger associations between certain risk factors and long-term MV by sex. For men, thyroiditis (OR 2.7 vs. 1.4 in women), cerebral infarction (OR 2.3 vs. 1.4), and acute pancreatitis (OR 3.2 vs. 1.0) were more strongly linked to weaning failure. For women, cerebrospinal fluid surgery (OR 5.7 vs. 2.0 in men) and acute pancreatitis (OR 4.7 vs. 3.0 in men) had stronger associations with long-term MV. ECLS and eating disorders were only linked to long-term MV in men. This study highlights sex differences in risk factors and outcomes for long-term MV, suggesting the need for sex-specific management strategies. Trial registration: The PRiVENT study was retrospectively registered at ClinicalTrials.gov (NCT05260853). Registered at March 2, 2022.
Article Details
Authors (93)
Franziska C. Trudzinski
Benjamin Neetz
Jana Dahlhoff
Philipp Höger
Axel Kempa
Claus Neurohr
Armin Schneider
Felix J. F. Herth
Biljana Joves
Joachim Szecsenyi
Elena Biehler
Thomas Fleischhauer
Janina Schubert-Haack
Thomas Grobe
Timm Frerk
Gabriele Iberl
Julia Dorothea Michels-Zetsche
Michael Müller
Julius-Maximilians-Universität Würzburg, Institute of Inorganic Chemistry, Institute for Sustainable Chemistry & Catalysis with Boron (ICB), Am Hubland, 97074 Würzburg, Germany
Andreas Rheinhold
Ahmed Ehab
Alessandro Ghiani
Nina Lutz
Swenja Walcher
Konstantinos Tsitouras
Joanna Paderewska
Selina Briese
Christoph Rauch
Patrick Gehrig
Joachim Sugg
Susanne Hirschmann
Thomas Fleischhhauer
Gerhard Fuchs
Nicola Litke
Markus Qreini
Michel Wensing
Anja Klingenberg
Teresa Byczkowski
Manuel Feißt
Simone Britsch
Christa Straub
Claude Jabbour
Michael Hahn
Jörg Krebs
Peter-Tobias Graf
Petra Denzer
Uta Merle
Monica Boxberger
Mascha Fiedler-Kalenka
Guido Hundt
Jens Regula
Thushira Weerawarna
Miriane Bomeken
Lisa Amega
Shumallah Basit
Sebastian Stier
Matthias Körner
Jens Müller
Sergej Markin
Ute Oltmanns
Oliver Gorgs
Mark Hackbarth
Sebastian Münz
Dominik Scharpf
Thomas J. Dengler
Mathias Borst
Brigitte Mayer
Wolfgang Reikow
Markus Kredel
Patrick Keppeler
Konstantin Frey
Holger Wolff
Florian Seidlitz
Stefanie Bientzle
Boris Nohé
Sebastian Allgäuer
Alexej Schöpp
Jörg Winckelmann
Christoph Schlegel
Imke Hübner
Andrzej Kuzniar
Helene Häberle
Reimer Riessen
Benjamin Schempf
Ingo Rebenschütz
Andreas Straub
Marc Kollum
Markus Winter
Paul Hartveg
Andreas Junginger
Thomas Abt
Mathias Vogel
Ralf Völker
Thomas Wiesmann