Absence of gender-based differences in outcome of patients with hospital-acquired pneumonia

Fernando Caceres, Verna L. Welch, Daniel H Kett, Ernesto G. Scerpella, Paula Peyrani, Kimbal D. Ford, Julio A. Ramirez

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Abstract

Background: The objective of this analysis was to evaluate the association between gender and clinical outcomes in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) since data thus far are controversial. Methods: Data from a convenience sample of ICU patients with HAP, including ventilator-associated and health care-associated pneumonia, were retrospectively collected from four academic institutions (Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia [IMPACT-HAP] study). Outcomes included 28-day mortality, clinical failure at day 14, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. We compared baseline characteristics and performed multivariate analysis to identify factors independently associated with mortality. Results: Among 416 patients, 271 were men and 145 were women. Women were older (62.4±16.9 vs. 55.7±16.5 years, p<0.001) and more critically ill, with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 21 vs. 19 (p=0.004). Day-28 mortality was 30% for women and 24% for men (p=0.25). Increased 28-day mortality was associated with severity of illness, age, ventilator-associated pneumonia, vascular disease, and hospital LOS prior to pneumonia diagnosis. No significant differences were found in the distribution of bacteria pathogens or in clinical failure rates (36% vs. 31%) between genders. Duration in days of mechanical ventilation, ICU LOS and hospital LOS after the diagnosis of pneumonia were not significantly different between men and women. Analyzing data for women based on presumed pre-or postmenopausal status (age breakpoint of 50 years), showed an increased in ICU LOS (15 vs. 25 days; p=0.0026) and hospital LOS (22 vs. 30 days; p=0.05) for women ≤50 years. No differences were noted in 28-day mortality (24.3% vs. 13.1%; p=0.18) in women ≤50 years of age. Conclusions: In ICU patients with pneumonia, female gender was not associated with worse outcomes or increased resource utilization compared to male gender. Further studies are needed to evaluate menopausal status and outcomes in women with pneumonia.

Original languageEnglish
Pages (from-to)1069-1075
Number of pages7
JournalJournal of Women's Health
Volume22
Issue number12
DOIs
StatePublished - Dec 1 2013

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Length of Stay
Pneumonia
Intensive Care Units
Mortality
Ventilator-Associated Pneumonia
Artificial Respiration
APACHE
Critical Pathways
Vascular Diseases
Critical Illness
Multivariate Analysis
Medicine
Bacteria
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Caceres, F., Welch, V. L., Kett, D. H., Scerpella, E. G., Peyrani, P., Ford, K. D., & Ramirez, J. A. (2013). Absence of gender-based differences in outcome of patients with hospital-acquired pneumonia. Journal of Women's Health, 22(12), 1069-1075. https://doi.org/10.1089/jwh.2013.4434

Absence of gender-based differences in outcome of patients with hospital-acquired pneumonia. / Caceres, Fernando; Welch, Verna L.; Kett, Daniel H; Scerpella, Ernesto G.; Peyrani, Paula; Ford, Kimbal D.; Ramirez, Julio A.

In: Journal of Women's Health, Vol. 22, No. 12, 01.12.2013, p. 1069-1075.

Research output: Contribution to journalArticle

Caceres, F, Welch, VL, Kett, DH, Scerpella, EG, Peyrani, P, Ford, KD & Ramirez, JA 2013, 'Absence of gender-based differences in outcome of patients with hospital-acquired pneumonia', Journal of Women's Health, vol. 22, no. 12, pp. 1069-1075. https://doi.org/10.1089/jwh.2013.4434
Caceres, Fernando ; Welch, Verna L. ; Kett, Daniel H ; Scerpella, Ernesto G. ; Peyrani, Paula ; Ford, Kimbal D. ; Ramirez, Julio A. / Absence of gender-based differences in outcome of patients with hospital-acquired pneumonia. In: Journal of Women's Health. 2013 ; Vol. 22, No. 12. pp. 1069-1075.
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abstract = "Background: The objective of this analysis was to evaluate the association between gender and clinical outcomes in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) since data thus far are controversial. Methods: Data from a convenience sample of ICU patients with HAP, including ventilator-associated and health care-associated pneumonia, were retrospectively collected from four academic institutions (Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia [IMPACT-HAP] study). Outcomes included 28-day mortality, clinical failure at day 14, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. We compared baseline characteristics and performed multivariate analysis to identify factors independently associated with mortality. Results: Among 416 patients, 271 were men and 145 were women. Women were older (62.4±16.9 vs. 55.7±16.5 years, p<0.001) and more critically ill, with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 21 vs. 19 (p=0.004). Day-28 mortality was 30{\%} for women and 24{\%} for men (p=0.25). Increased 28-day mortality was associated with severity of illness, age, ventilator-associated pneumonia, vascular disease, and hospital LOS prior to pneumonia diagnosis. No significant differences were found in the distribution of bacteria pathogens or in clinical failure rates (36{\%} vs. 31{\%}) between genders. Duration in days of mechanical ventilation, ICU LOS and hospital LOS after the diagnosis of pneumonia were not significantly different between men and women. Analyzing data for women based on presumed pre-or postmenopausal status (age breakpoint of 50 years), showed an increased in ICU LOS (15 vs. 25 days; p=0.0026) and hospital LOS (22 vs. 30 days; p=0.05) for women ≤50 years. No differences were noted in 28-day mortality (24.3{\%} vs. 13.1{\%}; p=0.18) in women ≤50 years of age. Conclusions: In ICU patients with pneumonia, female gender was not associated with worse outcomes or increased resource utilization compared to male gender. Further studies are needed to evaluate menopausal status and outcomes in women with pneumonia.",
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N2 - Background: The objective of this analysis was to evaluate the association between gender and clinical outcomes in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) since data thus far are controversial. Methods: Data from a convenience sample of ICU patients with HAP, including ventilator-associated and health care-associated pneumonia, were retrospectively collected from four academic institutions (Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia [IMPACT-HAP] study). Outcomes included 28-day mortality, clinical failure at day 14, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. We compared baseline characteristics and performed multivariate analysis to identify factors independently associated with mortality. Results: Among 416 patients, 271 were men and 145 were women. Women were older (62.4±16.9 vs. 55.7±16.5 years, p<0.001) and more critically ill, with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 21 vs. 19 (p=0.004). Day-28 mortality was 30% for women and 24% for men (p=0.25). Increased 28-day mortality was associated with severity of illness, age, ventilator-associated pneumonia, vascular disease, and hospital LOS prior to pneumonia diagnosis. No significant differences were found in the distribution of bacteria pathogens or in clinical failure rates (36% vs. 31%) between genders. Duration in days of mechanical ventilation, ICU LOS and hospital LOS after the diagnosis of pneumonia were not significantly different between men and women. Analyzing data for women based on presumed pre-or postmenopausal status (age breakpoint of 50 years), showed an increased in ICU LOS (15 vs. 25 days; p=0.0026) and hospital LOS (22 vs. 30 days; p=0.05) for women ≤50 years. No differences were noted in 28-day mortality (24.3% vs. 13.1%; p=0.18) in women ≤50 years of age. Conclusions: In ICU patients with pneumonia, female gender was not associated with worse outcomes or increased resource utilization compared to male gender. Further studies are needed to evaluate menopausal status and outcomes in women with pneumonia.

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