Gender Differences in Outcomes of Ambulatory and Hospitalized Patients With Obesity Hypoventilation Syndrome.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Chest Pub Date : 2024-10-09 DOI:10.1016/j.chest.2024.10.002
Nathan C Nowalk, Babak Mokhlesi, Julie M Neborak, Juan Fernando Masa Jimenez, Ivan Benitez, Francisco J Gomez de Terreros, Auxiliadora Romero, Candela Caballero-Eraso, Maria F Troncoso, Mónica González, Soledad López-Martín, José M Marin, Sergi Martí, Trinidad Díaz-Cambriles, Eusebi Chiner, Carlos Egea, Isabel Utrabo, Ferran Barbe, Maria Ángeles Sánchez-Quiroga
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引用次数: 0

Abstract

Background: Obesity hypoventilation syndrome (OHS) is associated with high morbidity and mortality. There are few data on whether there are gender differences in outcomes.

Research question: Is female gender associated with worse outcomes in ambulatory and hospitalized patients with OHS?

Study design and methods: Post hoc analyses were performed on 2 separate OHS cohorts: (1) stable ambulatory patients from the 2 Pickwick randomized controlled trials; and (2) hospitalized patients with acute-on-chronic hypercapnic respiratory failure from a retrospective international cohort. We first conducted bivariate analyses of baseline characteristics and therapeutics between genders. Variables of interest from these analyses were then grouped into linear mixed effects models, Cox proportional hazards models, or logistic regression models to assess the association of gender on various clinical outcomes.

Results: The ambulatory prospective cohort included 300 patients (64% female), and the hospitalized retrospective cohort included 1,162 patients (58% female). For both cohorts, women were significantly older and more obese than men. Compared with men, baseline Paco2 was similar in ambulatory patients but higher in hospitalized women. In the ambulatory cohort, in unadjusted analysis, women had increased risk of emergency department visits. However, gender was not associated with the composite outcome of emergency department visit, hospitalization, or all-cause mortality in the fully adjusted model. In the hospitalized cohort, prescription of positive airway pressure was less prevalent in women at discharge. In unadjusted analysis, hospitalized women had a higher mortality at 3, 6, and 12 months following hospital discharge compared with men. However, after adjusting for age, gender was not associated with mortality.

Interpretation: Although the diagnosis of OHS is established at a more advanced age in women, gender is not independently associated with worse clinical outcomes after adjusting for age. Future studies are needed to examine gender-related health disparities in diagnosis and treatment of OHS.

肥胖换气不足综合征门诊和住院病人治疗效果的性别差异。
背景:肥胖低通气综合征(OHS)与高发病率和高死亡率有关。关于预后是否存在性别差异的数据很少。研究问题:女性是否与肥胖低通气综合征门诊和住院患者较差的预后有关?我们对两组不同的 OHS 患者进行了事后分析:1)来自两项皮克维克随机对照试验的稳定的非卧床患者;2)来自一项回顾性国际队列的急性-慢性高碳酸血症呼吸衰竭住院患者。我们首先对不同性别的基线特征和治疗方法进行了双变量分析。然后将这些分析中的相关变量分组到线性混合效应模型、Cox 比例危险模型或逻辑回归模型中,以评估性别与各种临床结果的关系:流动前瞻性队列包括 300 名患者(64% 为女性),住院回顾性队列包括 1 162 名患者(58% 为女性)。在这两个队列中,女性的年龄和肥胖程度都明显高于男性。与男性相比,非住院患者的基线 PaCO2 与男性相似,但住院女性的基线 PaCO2 较高。在门诊队列中,未经调整的分析显示,女性看急诊的风险更高。然而,在完全调整模型中,性别与急诊就诊、住院或全因死亡率的综合结果无关。在住院患者队列中,女性出院时较少使用气道正压(PAP)处方。在未经调整的分析中,与男性相比,住院女性在出院后 3、6 和 12 个月的死亡率较高。然而,在对年龄进行调整后,性别与死亡率无关:解释:虽然女性确诊 OHS 的年龄较高,但在调整年龄因素后,性别与较差的临床结果并无独立关联。今后还需要开展研究,探讨在诊断和治疗 OHS 方面与性别相关的健康差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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