Sex Differences in Vital Organ Support Provided to ICU Patients*

Abstract

Objectives: Critically ill women may receive less vital organ support than men but the mortality impact of this differential treatment remains unclear. We aimed to quantify sex differences in vital organ support provided to adult ICU patients and describe the relationship between sex, vital organ support, and mortality. Design: In this retrospective observational study, we examined the provision of invasive ventilation (primary outcome), noninvasive ventilation, vasoactive medication, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), or any one of these five vital organ supports in women compared with men. We performed logistic regression investigating the association of sex with each vital organ support, adjusted for illness severity, diagnosis, preexisting treatment limitation, year, and hospital. We performed logistic regression for hospital mortality adjusted for the same variables, stratified by vital organ support (secondary outcome). Setting and Patients: ICU admissions in the Australia and New Zealand Intensive Care Society Adult Patient Database 2018–2021. This registry records admissions from 90% of ICUs in the two nations. Interventions: None. Measurements and Main Results: We examined 699,535 ICU admissions (43.7% women) to 199 ICUs. After adjustment, women were less likely than men to receive invasive ventilation (odds ratio [OR], 0.64; 99% CI, 0.63–0.65) and each other organ support except ECMO. Women had lower adjusted hospital mortality overall (OR, 0.94; 99% CI, 0.91–0.97). Among patients who did not receive any organ support, women had significantly lower adjusted hospital mortality (OR, 0.82; 99% CI, 0.76–0.88); among patients who received any organ support women and men were equally likely to die (OR, 1.01; 99% CI, 0.97–1.04). Conclusions: Women received significantly less vital organ support than men in ICUs in Australia and New Zealand. However, our findings suggest that women may not be harmed by this conservative approach to treatment.

Sex differences in the SOFA score of ICU patients with sepsis or septic shock: a nationwide analysis

“…In our cohort, women less frequently received treatment with multiple vasoactive agents and interventions while in intensive care, yet no differences in ICU mortality or ICU LOS were observed. This aligns with a recent study in 699,535 ICU patients that reported an even lower overall hospital mortality in women despite significantly less organ support compared to men [ 42 ]. However, the impact of the sex-imbalance in provision of ICU care on long-term survival remains uncertain at this point.…”

“…It has been previously claimed that women are less frequently admitted to ICUs [ 8 , 40 ] and undertreated compared to men, both before and during ICU admission, despite being equally or even more severely ill [ 3 , 8 , 41 , 42 ]. This included less use of mechanical ventilation and renal replacement therapy and earlier discharge from ICU [ 41 ].…”

“…Sensitivity analyses excluding all patients with an advance directive revealed no sex differences regarding ICU outcomes. Limitations of medical treatment prior to ICU admission were also not accountable for the sex-related differences in ICU interventions and outcomes [ 42 ]. However, the impact of existing advance directives on sex disparities in ICU admission, and thus underrepresentation of female ICU patients in multiple diagnoses [ 40 ], remains unclear.…”

The Potential Role of Gender in the Incidence, Management, and Outcomes of Stroke in Patients Suffering From COVID-19: A Brief Review

“…Available data, albeit limited, point towards the direction of worse outcomes among men despite a more frequent use of advanced therapies in men compared to women. The latter is in accordance with other evidence of (i) gender discrimination in regards to the triage upon ICU admission (women are less frequently admitted to the ICU, as compared to men, despite more grave disease [26]), and (ii) a gender-driven differential in the treatment modalities offered to ICU patients (women have been found to receive less vital organ support within the ICU setting [27]). It is essential to emphasize that while our study does not specifically investigate gender discrimination in the ICU context, we contribute to the broader discussion on gender-related disparities in critical care.…”

Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

“…Contrary to the results of experimental studies [116,117], a possible effect of the sexual hormones on the Doppler blood flow velocities in cerebral vessels in patients with aSAH could not be demonstrated [118]. Furthermore, sex-related differences in the management and delivery of care of patients with aSAH to the disadvantage of women-as already shown in other medical conditions-could play a role in the development of DCI, and these should be further investigated [119][120][121].…”