Sex-based differences in ICU management and outcomes of immunocompromised patients: A post hoc analysis of the prospective multicenter multinational Efraim cohort
Bibliographic record
Abstract
PURPOSE: There may be sex-based disparities in intensive care unit (ICU) management and outcomes. We compared baseline variables, interventions, and outcomes of immunocompromised critically ill men and women. METHODS: We performed a post hoc analysis of the Efraim study, a prospective multinational cohort study of immunocompromised adults with acute hypoxemic respiratory failure admitted to one of 68 ICU in 16 countries between November 2015 and July 2016. We compared in unadjusted and adjusted analyses baseline variables, ICU interventions, and outcomes between men and women. RESULTS: We included 1536 immunocompromised adults (922 men, 614 women) in this study. Women and men had similar age, BMI, and diagnoses leading to immunosuppression; hematopoietic cell transplant was more common in men. On the first ICU day, SOFA score was higher in men vs. women (7 [IQR 4-10] vs 6 [4-10]), p = 0.0005). The use of ICU supportive interventions, including mechanical ventilation, vasopressors, renal replacement, bronchoalveolar lavage, and ARDS adjuncts, were similar between men and women; as were mortality in ICU, in hospital, and at 90 days. After adjustment, female sex (sub-hazard ratio 1.19, 95 % CI 1.05-1.36, p = 0.007), SOFA score on ICU day 1 (sHR 1.16, 95 % CI 1.12-1.19, p < 0.001) and chronic kidney disease (sHR 0.74, 95 % CI 0.59-0.93, p = 0.009) were associated with mechanical ventilation. Age, performance status and SOFA score on ICU day 1 were associated with hospital mortality. CONCLUSIONS: In this post hoc analysis of immunocompromised adult ICU patients with hypoxemic respiratory failure, women and men received similar ICU interventions, and had similar outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".