Sex-Based Differences in ICU Management and Outcomes of Immunocompromised Patients: A Post Hoc Analysis of the Prospective Multicenter Multinational Efraim Cohort
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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BibTeX
@article{mehta2026sexbased,
title = {{Sex-Based Differences in ICU Management and Outcomes of Immunocompromised Patients: A Post Hoc Analysis of the Prospective Multicenter Multinational Efraim Cohort}},
author = {Sangeeta Mehta and Elie Azoulay and Laveena Munshi and Alexandre Demoule and Anders Perner and Tine Sylvest Meyhoff and Philippe R. Bauer and Victoria Metaxa and Frédéric Pène and Christophe Girault and Márcio Soares and Fabio Silvio Taccone and Massimo Antonelli and Francois Barbier and Andreas Barratt-Due and Fabrice Bruneel and Ramin Brandt Bukan and Gastón Burghi and Sylvie Chevret and Benjamin Gaborit and Pleun Hemelaar and Achille Kouatchet and Precious Pearl Landburg and Virginie Lemiale and Ignacio Martin-Loeches and Djamel Mokart and Anne-Sophie Moreau and Luca Montini and Lene Bjerregaard Nielsen and Peter Pickkers and Jordi Rello and Katerina Rusinova and Jorge Salluh and Peter Schellongowski and Virginie Souppart and Nicolas Terzi and Miia Valkonen and Andry van De Louw and Michael Darmon},
journal = {Journal of Critical Care},
year = {2026},
month = oct,
doi = {10.1016/j.jcrc.2025.155149},
url = {https://normandie-univ.hal.science/hal-05834786v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Sex-Based Differences in ICU Management and Outcomes of Immunocompromised Patients: A Post Hoc Analysis of the Prospective Multicenter Multinational Efraim Cohort
AU - Sangeeta Mehta
AU - Elie Azoulay
AU - Laveena Munshi
AU - Alexandre Demoule
AU - Anders Perner
AU - Tine Sylvest Meyhoff
AU - Philippe R. Bauer
AU - Victoria Metaxa
AU - Frédéric Pène
AU - Christophe Girault
AU - Márcio Soares
AU - Fabio Silvio Taccone
AU - Massimo Antonelli
AU - Francois Barbier
AU - Andreas Barratt-Due
AU - Fabrice Bruneel
AU - Ramin Brandt Bukan
AU - Gastón Burghi
AU - Sylvie Chevret
AU - Benjamin Gaborit
AU - Pleun Hemelaar
AU - Achille Kouatchet
AU - Precious Pearl Landburg
AU - Virginie Lemiale
AU - Ignacio Martin-Loeches
AU - Djamel Mokart
AU - Anne-Sophie Moreau
AU - Luca Montini
AU - Lene Bjerregaard Nielsen
AU - Peter Pickkers
AU - Jordi Rello
AU - Katerina Rusinova
AU - Jorge Salluh
AU - Peter Schellongowski
AU - Virginie Souppart
AU - Nicolas Terzi
AU - Miia Valkonen
AU - Andry van De Louw
AU - Michael Darmon
PY - 2026
DA - 2026/10/22
JO - Journal of Critical Care
DO - 10.1016/j.jcrc.2025.155149
UR - https://normandie-univ.hal.science/hal-05834786v1
AB - 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.
SN - 0883-9441
ER -