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

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.

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Journal
Scientific Reports
Published
2025-10-08
DOI
https://doi.org/10.1038/s41598-025-22399-z
Primary Topic
Respiratory Support and Mechanisms
Type
article
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article

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

Ingo Rebenschütz, Jörg Winckelmann, Wolfgang Reikow, Thomas Wiesmann et al.
Scientific Reports
Respiratory Support and Mechanisms
article

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

Ingo Rebenschütz, Jörg Winckelmann, Wolfgang Reikow, Thomas Wiesmann, Swenja Walcher, Patrick Keppeler, Sebastian Allgäuer, Anja Klingenberg, Patrick Gehrig, Michael Müller, Nina Lutz, Nicola Litke, Felix Herth, Stefanie Bientzle, Julia Dorothea Michels-Zetsche, Christa Straub, Joanna Paderewska, Alexej Schöpp, Biljana Joves, Boris Nohé, Florian Seidlitz, Jens Regula, Timm Frerk, Paul Hartveg, Sebastian Stier, Selina Briese, G. Iberl, Simone Britsch, Andreas Straub, Alessandro Ghiani, Sebastian Münz, Thomas Grobe, Thomas Fleischhhauer, Joachim Szécsényi, Joerg Krebs, Jens Müller, Joachim Sugg, Meike Körner, Dominik Scharpf, Andreas Rheinhold, Janina Schubert-Haack, Uta Merle, Markus Qreini, Christoph Rauch, Armin Schneider, Thomas Fleischhauer, Michel Wensing, С.С. Маркин, Imke Hübner, Manuel Feißt, Benjamin Schempf, Ute Oltmanns, Saima Basit, Markus Winter, Franziska Christina Trudzinski, Petra Denzer, Michael Hahn, Monica Boxberger, Peter-Tobias Graf, Mary E. Hackbarth, Marc Kollum, Christoph Schlegel, Susanne Hirschmann, Konstantin Frey, Benjamin Neetz, Κωνσταντίνος Τσίτουρας, Andreas Junginger, Guido Hundt, Brigitte Mayèr, Reimer Rießen, Elena Biehler, Markus Kredel, Miriane Bomeken, Mascha Onida Fiedler-Kalenka, Ahmed Ehab, Philipp Höger, J Dahlhoff, Helene Häberle, Thomas J. Dengler, Gerhard Fuchs, Axel Kempa, Ralf Völker, Holger Wolff, Mathias M. Borst, Mathias Vogel, Claus Neurohr, Claude Jabbour, Teresa Byczkowski, Thushira Weerawarna, Lisa Amega, Oliver Gorgs, Andrzej Kuzniar, Thomas Abt
article en

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.

Scientific ReportsVol. 15(1)
Heidelberg University (DE), University Hospital Heidelberg (DE), Robert Bosch Hospital (DE), Städtisches Klinikum Karlsruhe (DE), Löwenstein Medical (Germany) (DE), SRH Klinikum Karlsbad-Langensteinbach (DE), Zimmer Biomet (Germany) (DE), Ostalb-Klinikum Aalen (DE), Sana Kliniken AG (DE), Unfallkrankenhaus Berlin (DE), Klinikum Weiden (DE), Medizin Campus Bodensee (DE), Klinikum Esslingen (DE), Ordensklinikum Linz Barmherzige Schwestern (AT), Klinikum Ingolstadt (DE), University Children's Hospital Tübingen (DE), Kreiskliniken Reutlingen (DE), Hegau-Bodensee-Klinikum Singen (DE), German Centre for Cardiovascular Research (DE), German Center for Lung Research (DE), MVZ Labor Ravensburg (DE), Krankenhäuser Landkreis Freudenstadt (DE), Diabetesinstitut Heidelberg (DE), Schwetzingen Technical Institute & Graduate Court Registrars' College (DE), Klinik Donaustauf (DE), University and Rehabilitation Clinics Ulm (DE), Caritas-Krankenhaus Bad Mergentheim (DE), Waldburg-Zeil Kliniken (DE), DIAKO (DE), Klinikum im Friedrichshain (DE), Diakonie-Klinikum Stuttgart (DE), SLK-Kliniken Heilbronn (DE), Siloah St. Trudpert Klinikum (DE), University Medical Centre Mannheim (DE), University of Tübingen (DE), Furtwangen University (DE)
AstraZeneca, GlaxoSmithKline, Novartis, Gemeinsame Bundesausschuss, Grifols, Fundação para a Ciência e a Tecnologia
Openalex Percentile: Top 59%
Respiratory Support and Mechanisms
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