Sex-specific differences in risk factors and outcomes for long-term mechanical ventilation: a longitudinal cohort analysis of claims data

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.

Keywords: Invasive home mechanical ventilation; Long-term invasive mechanical ventilation; Predictive model; Prognostic factors; Prolonged weaning; Weaning; Weaning failure.

Fig. 1

Consort diagram of inclusions and exclusions.

Fig. 2

Odds ratios and prevalence of risk factors for long-term mechanical ventilation in men and women. The figure illustrates the odds ratios of individual risk factors along with their prevalence. Each circle represents a risk factor, with yellow circles corresponding to women and blue circles corresponding to men. Risk factors that were found to be non-significant in the individual analyses are shown as transparent circles. The size of each circle reflects the prevalence of the risk factor within the respective population. The outermost circle categorizes the different risk factors: blue represents diagnoses (chronic diseases at admission, admission diagnoses, and diagnoses within the last 365 days prior to admission), and red represents surgeries and procedures during the inpatient stay (hospital stay, 365 days prior to admission, and within the first 96 h of the inpatient stay). The area of each circle indicates the prevalence in the population. The dotted circle marks a hazard ratio of 1, with the distance of each comorbidity from the circle’s center reflecting the magnitude of the odds ratio (as shown in Table 2). Hazard ratios smaller than 1 are plotted inward, while those greater than 1 are plotted outward.