Li, Shifang

Abstract IntroductionPatients with interstitial lung disease (ILD) who are admitted to the intensive care unit (ICU) face significant challenges, with high rates of morbidity and mortality. Despite the severity of outcomes in this population, the potential impact of gender disparities on ICU outcomes in ILD has not been well studied.MethodsWe analyzed data from the NIS spanning 2016 to 2018, focusing on adults (≥18 years) hospitalized with ILD (J84), and defined ICU stays using ICD codes for central line placement and mechanical ventilation. The NIS, part of the Healthcare Cost and Utilization Project, provides a weighted, nationally representative sample of U.S. hospitalizations. Demographic, clinical, and hospital characteristics were collected, with race/ethnicity categorized per NIS classifications. Multivariable logistic and linear regression models adjusted for potential confounders to evaluate gender differences in outcomes.ResultsOur study identified 810,295 adult hospitalizations with ILD, of which 42,080 required ICU-level care. Of these, 46.7% were female. Female ICU patients were younger (mean age 66.9 ± 13.8 vs. 69.1 ± 12.7, p<0.001), more likely to be African American (17.0% vs. 10.9%, p<0.001), and less likely to be Caucasian (63.7% vs. 69.2%, p<0.001). Females were more often from lower-income ZIP codes (33.2% vs. 38.3%, p<0.001) and had lower rates of tobacco use disorder (35.0% vs. 43.9%, p<0.001). Mortality was significantly lower in females (40.5% vs. 48.1%, p<0.001). After adjusting for confounders, female gender was independently associated with reduced mortality risk (adjusted odds ratio 0.77, 95% CI 0.70-0.84, p<0.001) and a shorter length of hospital stay (adjusted difference 1.15 days, 95% CI 0.54-1.77).ConclusionOur study highlights notable gender differences in outcomes for patients with ILD admitted to the ICU. Female patients had a significantly lower risk of mortality and shorter hospital stays than male patients, even after adjusting for key clinical and socioeconomic confounders. These findings are consistent with emerging evidence that biological sex and gender-related factors play a critical role in disease expression and outcomes in ILD.Several mechanisms may explain these gender disparities. Sex hormones, such as estrogen, have been shown to exert protective effects in pulmonary fibrosis models, potentially influencing the disease course in women. Incorporating these considerations into clinical practice and future research will be vital for advancing individualized, patient-centered medicine in ILD.

Abstract Introduction:Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome characterized by excessive immune activation and cytokine release, leading to multi-organ failure and mortality. Despite guideline management to include chemotherapy and transplantation, the characteristics and predictors of critical outcomes in post-transplant-associated hemophagocytic lymphohistiocytosis (PT-HLH) remain poorly understood. Methods:This study is a retrospective cohort analysis of patients admitted to acute care hospitals in the U.S. with HLH between 2016 and 2018. We utilized the National Inpatient Sample, identifying HLH patients using International Classification of Diseases, Tenth Revision-Clinical Modification (ICD-10-CM) codes D76.1, D76.2, and D76.3. Patient demographics, such as age, gender, race, ethnicity, zip code, and insurance status, were obtained from the NIS, while hospital-level characteristics, location and teaching vs. non-teaching status, were considered in the study amongst others. We examined the baseline epidemiology of transplant status, including ICU-related outcomes and resource utilization in patients with and without transplants. Data were analyzed using STATA weighted function, with logistic regression for categorical outcomes. Results:Out of 8,330 adult HLH hospitalizations, 520 (6.2%) were transplant recipients. Among these, 350 (67%) had bone marrow transplants, 90 (17%) had kidney transplants, and 30 (5.8%) had liver transplants. The mean age of HLH patients was 50 ± 19 years; transplant patients were younger (mean age 46 ± 17 years) compared to non-transplant patients (50 ± 18 years), p<0.05. Transplant patients were more likely to be male (72.1% vs. 50.1%, p<0.05), have CMV infection (14.4% vs. 4.1%, p<0.05), be Hispanic (20.8% vs. 14.7%, p<0.05), come from higher median household income areas (38.8% vs. 24.5%, p<0.05), and be treated in teaching hospitals (96.1% vs. 85.8%, p<0.05). Among HLH patients who died in the hospital, 130 (25%) were transplant recipients, compared to 1,180 (15.1%) non-transplant recipients, p<0.05. After adjusting for potential confounders, transplant status was associated with a higher risk of mortality (adjusted odds ratio 1.77, 95% CI 1.11-2.83) and sepsis (adjusted odds ratio o1.78, 95% CI 1.08-2.92). Discussion:In examining a national cohort of PT-HLH cases, our findings review potential risk factors for critical care-related outcomes in post-transplant associated HLH care. PT-HLH patients in our cohort presented with distinct characteristics compared to non-transplant HLH cases. ICU-related outcomes showed statistically significant differences between transplant and non-transplant HLH patients. Specifically, transplant status remained independently associated with a higher risk of mortality and sepsis. Our findings underscore the importance of tailoring treatment plans to each patient's specific risk profile.