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Article

Gender-Based Differences in COPD Patients with Type 2 Respiratory Failure—Impact on Clinical Practice

by
Tarkan Ozdemir
1,*,
Murat Yıldız
1,
Maşide Arı
1,
Emrah Arı
2,
Güler Eraslan Doğanay
3,
Mustafa Özgür Cırık
3,
Melek Doğancı
3,
Çiğdem Özdilekcan
4,
Derya Kızılgöz
1 and
Yusuf Tuğrul Şipit
1
1
Department of Chest Diseases, Ankara Sanatoryum Training and Research Hospital, Ankara 06290, Turkey
2
Department of Emergency Medicine, Mamak Public Hospital, Ankara 06620, Turkey
3
Department of Anesthesiology, Ankara Sanatoryum Training and Research Hospital, Ankara 06290, Turkey
4
Department of Chest Diseases, Ankara Oncology Training and Research Hospital, Ankara 06200, Turkey
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(4), 587; https://doi.org/10.3390/medicina61040587
Submission received: 1 February 2025 / Revised: 18 March 2025 / Accepted: 20 March 2025 / Published: 25 March 2025
(This article belongs to the Special Issue Chronic Respiratory Diseases: Updates on Pathophysiology, Symptoms, Diagnosis and Treatment)
Browse Figure
Versions Notes

Abstract

:
Background and Objectives: To contribute to clinical practice by identifying gender-based differences in patients diagnosed with chronic obstructive pulmonary disease (COPD) who are monitored in the intensive care unit due to type 2 respiratory failure. Materials and Methods: The study was planned as a prospective, observational, and cross-sectional investigation. A total of 258 patients, 91 females and 167 males, were included in the study between 2023 and 2024. Demographic data and clinical parameters of COPD patients admitted to intensive care due to hypercapnic respiratory failure and treated with noninvasive ventilation (NIV) were compared between genders. Results: The number of male patients was higher than female patients, while the mean age of female patients was higher than that of males. The body mass index (BMI), morbid obesity, atrial fibrillation, renal disease, heart failure, hypertension, hypothyroidism, the Charlson Comorbidity Index (CCI), and the cardiothoracic ratio were found to be significantly higher in female patients. Emphysema and steroid use in treatment were more common in male patients. In laboratory analyses conducted at the time of admission, the average D-dimer and brain natriuretic peptide (BNP) levels were higher in female patients. The mean arterial carbon dioxide pressure (PaCO2) level assessed prior to discharge was also higher in female patients. Conclusions: Heart failure and risk factors that may lead to heart failure are more prominent in female COPD patients with type 2 respiratory failure. Despite the lower number of female patients compared to males, the significantly higher comorbidity burden in females, as per CCI scores, suggests that medical processes may be more challenging to manage in females. We believe that these findings will contribute to clinical practice and provide clinicians with insights for patient management.

1. Introduction

Chronic obstructive pulmonary disease (COPD) ranks among the leading causes of morbidity and mortality globally [1]. COPD is the third leading cause of death in the United States (US) [2]. The prevalence and burden of COPD are expected to increase in the coming decades due to continued exposure to risk factors and an aging global population [3]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) reports an overall prevalence of COPD at 11.8% in men and 8.5% in women [4], with significantly higher prevalence in men than women [5]. However, from 2001 to 2019, COPD prevalence has been steadily rising among women [6]. Although COPD is still primarily considered a “male disease”, mortality rates among men have been decreasing in some countries, such as the US and the United Kingdom, while remaining relatively unchanged among women [7,8].
Hypercapnic respiratory failure (HRF), also known as type 2 respiratory failure (T2RF), is characterized by an increase in the arterial carbon dioxide (CO2) pressure (PaCO2). CO2 levels in arterial blood are directly proportional to CO2 production and inversely proportional to alveolar ventilation. Increased dead space and decreased minute ventilation are common causes of hypercapnia [9]. During exacerbations, ventilation–perfusion (VA/Q) mismatches occur, potentially leading to arterial hypoxemia with or without hypercapnia [10]. Hypercapnia should always be suspected in individuals at risk of hypoventilation (e.g., sedative use, history of sleep apnea) or with increased physiological dead space and limited pulmonary reserve (e.g., COPD exacerbation) presenting with symptoms, such as dyspnea or altered mental status [9]. Acute or acute-on-chronic hypercapnia may develop during exacerbations or in response to oxygen therapy in some COPD patients [9]. Immediate admission to the intensive care unit (ICU) may be necessary for some cases. Ventilatory support during a COPD exacerbation can be provided via noninvasive (nasal or facial mask) or invasive ventilation [11]. Noninvasive ventilation (NIV) is the preferred first-line treatment for acute respiratory failure due to COPD exacerbations, with an 80–85% success rate in hypercapnic patients [12].
Many funding agencies in Europe and North America have implemented policies to encourage or mandate the consideration of sex and gender in medical research at all levels [13]. Despite significant advances in intensive care medicine, limited attention has been given to gender differences in the management and outcomes of ICU patients [14]. Although half of the global population comprises women, they account for only 35–45% of ICU patients [15]. Clinical presentations, comorbidities, and prognoses may differ by gender, potentially affecting treatment decisions [16].
A review of the literature reveals numerous studies on gender–COPD and gender–ICU topics. In these studies, multiple parameters, including demographic data, the severity of illness, comorbidities, Charlson Comorbidity Index (CCI), clinical and laboratory parameters, treatment responses, the need for mechanical ventilation, the length of hospital stay, mortality, and readmission rates, were compared among patients diagnosed with COPD or those followed in the ICU, stratified by gender, to identify similarities and differences [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30].
However, no study has specifically compared COPD patients with T2RF treated with NIV based on gender. This study aims to identify gender-based differences in patients with HRF treated with NIV and to contribute findings to clinical practice.

2. Materials and Methods

2.1. Study Design and Inclusion and Exclusion Criteria

Our study is prospective, observational, and cross-sectional. Since the study was observational, it was planned according to routine laboratory and radiologic examinations. Patients admitted to the second-level pulmonary ICU between 30 March 2023 and 30 March 2024 for T2RF and clinically stabilized with NIV before discharge were included. The hospital where the study was conducted is located in Ankara, the second largest city and capital of Türkiye. The estimated population of Ankara in 2025 is 5,909,658. The study was conducted in a university hospital with a capacity of 500 beds, which serves as a reference hospital for the pulmonology department. The secondary-level pulmonary intensive care department consists of two separate units with 11 and 12 beds, respectively. The patients included in the study were those followed in the 11-bed unit. There are a total of 14 NIV devices, 4 high flow oxygen devices, and 2 mechanical ventilator devices in the ward. The healthcare staff in the unit is trained and experienced in NIV application. There are 16 nurses working in shifts in the ward; 1 specialist physician and 2 assistant physicians work during the day, and 1 specialist physician and 1 assistant physician work on duty. In addition, to assist the nurses, 3 patient care personnel work during the daytime and 1 patient care personnel works during the on-call hours; 91 female and 167 male patients were enrolled in the study. Inclusion criteria were as follows: patients were over 40 years of age; patients had previously been diagnosed with COPD; patients had previously received a medication report for COPD medications; patients presented with hypercapnic respiratory failure. Exclusion criteria were as follows: included patients with type 1 respiratory failure (T1RF) alone; patients without a COPD diagnosis; those requiring intubation after NIV; patients transferred to third-level ICUs; COVID-19 PCR-positive patients transferred to COVID ICUs; patients who died during hospitalization for unrelated reasons; and patients with chronic hypercapnia previously using home BPAP. The inclusion and exclusion criteria of patients in the study were shown as a flowchart (Figure 1).

2.2. Data Collection and Study Protocol

Informed consent was obtained from patients prior to data collection. Patient files and the hospital information-management system served as data sources. In addition to demographic data, comorbidities, treatments received, long-term device use reports, length of stay, and routine laboratory parameters were recorded. To make a diagnosis of emphysema, new or previous thorax computed tomography scans of the patients were analyzed together with their reports through the radiological imaging system.

2.3. Descriptions

Standardized variables, such as the body mass index, Charlson comorbidity index, and cardiothoracic ratio, were used to compare the study groups.
Body Mass Index (BMI): BMI values were calculated as the ratio of height squared to body weight (kg/m2). The classification recommended by the World Health Organization was used: underweight below 18.5 kg/m2 was considered underweight, normal between 18.5–24.9 kg/m2, overweight between 25–29.9 kg/m2, obese above 30 kg/m2 and morbidly obese above 40 kg/m2 [31].
The Charlson comorbidity index (CCI) is one of the most commonly used methods to assess comorbid factors and predict mortality. The CCI takes into account many underlying conditions, such as age, kidney diseases, malignancies, cerebrovascular diseases, liver diseases, and lung diseases. Scoring is based on 19 medical conditions and is calculated based on variable morbidity rates in the patient population. The severity of morbidities is graded from 1 to 4 [32].
Cardiothoracic ratio: The cardiothoracic ratio (CTR), which expresses the relationship between the transverse size of the chest and the size of the heart measured on postero-anterior chest radiography, is a commonly used parameter in the evaluation of cardiomegaly and has a cut-off value of 0.5. A value greater than 0.5 should be interpreted as an enlarged heart [33].
Classification of disease groups was made according to the ICD 10 coding system used in Türkiye [34]: C34, malignant neoplasm of the bronchus and lung; D50, iron deficiency anemia; D51, vitamin B12 deficiency anemia; D52, folate deficiency anemia; D53, other nutritional anemias; E02, subclinical iodine-deficiency hypothyroidism; E03, other hypothyroidism; E66.2, extreme obesity with alveolar hypoventilation; E10, type 1 diabetes mellitus; E11, type 2 diabetes mellitus; F03, unspecified dementia; F20, schizophrenia; F41, other anxiety disorders; F41.2, anxiety depression; F32, depressive episode; G47.3, sleep apnea; G20, Parkinson disease; G30, dementia in Alzheimer disease; I10, essential (primary) hypertension; I25.1, atherosclerotic heart disease; I48, atrial fibrillation and flutter; I50, heart failure; I69, sequelae of cerebrovascular disease; I26, pulmonary embolism; J44.1, COPD with acute exacerbation; J96.0, acute respiratory failure; J47, bronchiectasis; J09-J18, pneumonia; J43, emphysema; M40.0, postural kyphosis; M40.1, other secondary kyphosis; M40.2, other and unspecified kyphosis; M41.3, thoracogenic scoliosis; N17, acute renal failure; N18, chronic kidney disease; N19, unspecified kidney failure; Q76.3, congenital scoliosis due to congenital bony malformation.

2.4. Statistical Analysis

The data were analyzed using the Statistical Package for Social Sciences (SPSS) Windows 27.0 software (Chicago, IL, USA). The normality of data distribution was evaluated using the Kolmogorov–Smirnov test and histograms. Numerical data with a normal distribution were presented as the mean ± standard deviation, while non-normally distributed numerical data were presented as the median and minimum–maximum values (IQR 25–75%). Categorical variables were expressed as numbers (n) and percentages (%). Categorical variables were compared using the Chi-square or Fisher’s Exact test, while continuous variables were compared using the Student’s t-test or Mann–Whitney U test. The Kruskal–Wallis analysis was used to compare more than two continuous variables. A p-value < 0.05 was considered statistically significant for all tests.

2.5. Ethical Considerations

Ethical approval for the study was obtained from the Ethics Committee of Ankara Sanatorium Training and Research Hospital (Date: 22 February 2023; No: 2012-KAEK-15/2644).

3. Results

Table 1 evaluates the gender distribution, ages, comorbidities, treatments, and hospital stay durations of the patients. The study was conducted with a total of 258 patients. Of these, 91 (35.3%) were female and 167 (64.7%) were male (p < 0.01). The mean age of the patients was 69 ± 10 years. The mean age of female patients was 72 ± 12 years, significantly higher than that of male patients (68 ± 8 years, p = 0.003) (Table 1). When comorbidities were compared by gender, body mass index (BMI) (p < 0.001), morbid obesity (p < 0.001), atrial fibrillation (p = 0.023), renal disease (p = 0.027), neurological diseases (p = 0.005), heart failure (p < 0.001), hypertension (p < 0.001), hypothyroidism (p = 0.024), CCI (p = 0.02), and CTR (p < 0.001) were significantly higher in female patients than in males (Table 2). Emphysema was significantly higher in male patients than in females (p < 0.001) (Table 1).
No significant differences were found in the gender comparison of patients prescribed long-term bilevel positive airway pressure (BPAP) at home (p = 0.730) or long-term oxygen therapy (LTOT) at home (p = 0.765) (Table 1).
When comparing treatments (antibiotics, steroids, antidepressants, anxiolytics, nutritional support), the number of male patients receiving steroid therapy was significantly higher than female patients (p = 0.004) (Table 1).
There were no significant differences in hospital stay durations between genders (p = 0.926) (Table 1).
Table 2 evaluates the laboratory parameters of the patients. In the analysis of laboratory parameters at admission, the average D-dimer value (p = 0.036) and brain natriuretic peptide (BNP) value (p = 0.04) were significantly higher in female patients than in males (Table 2). No significant differences were found in the comparison of pH compensation-decompensation in blood gas analysis at admission by gender (Table 2).
In the hemogram analyses conducted at admission and prior to discharge, the mean hemoglobin levels were significantly higher in male patients than in females (p < 0.001, p < 0.001) (Table 2).
In the blood gas analyses performed before discharge, the mean partial carbon dioxide pressure (PaCO2) (p = 0.036), actual bicarbonate (aHCO3) (p = 0.031), actual base excess (aBe) (p = 0.021), and standard base excess (sBE) (p = 0.035) values were significantly higher in female patients than in males. Additionally, in the biochemistry analysis, the mean sodium levels (p = 0.003) were significantly higher in female patients (Table 2).
Although not shown in the table, the lymphocyte/WBC ratio at admission, lymphocyte/WBC ratio at discharge, monocyte/WBC ratio at admission, monocyte/WBC ratio at discharge, neutrophil/WBC ratio at admission, neutrophil/WBC ratio at discharge, eosinophil/WBC ratio at admission, eosinophil/WBC ratio at discharge, basophil/WBC ratio at admission, and basophil/WBC ratio at discharge showed no significant differences between males and females (p = 0.25, p = 0.19, p = 0.34, p = 0.96, p = 0.52, p = 0.09, p = 0.75, p = 0.37, p = 0.89, p = 0.24, respectively). Additionally, no significant differences were found in blood group parameters (A, B, O, AB) when compared by gender (p = 0.92).

4. Discussion

Our study is the first to compare clinical parameters by gender in COPD patients treated with NIV and other medical therapies for T2RF in the ICU and subsequently discharged. The strength of the study is that it was conducted prospectively in an intensive care unit where a team experienced in NIV application worked and specialized in this field. The number of male patients was higher than that of females. The mean age of female patients was significantly higher than that of males. BMI, morbid obesity, atrial fibrillation, renal disease, heart failure, hypertension, hypothyroidism, CCI, BNP, BUN, D-dimer, CTR assessed on the first day of hospitalization, and PaCO2 measured before discharge were significantly higher in females. The presence of emphysema and the use of steroids in treatment were significantly more common in males. No significant gender differences were observed in patients prescribed long-term BPAP or oxygen therapy for home use.
A study examining the epidemiology of COPD in Türkiye using health insurance data found that 56.2% of physician-diagnosed COPD patients were male and 43.8% were female [35]. Another study on COPD exacerbations in Türkiye reported that 85% of the patients were male, while 15% were female [36]. Studies examining ICU patients have shown that the number of male patients is consistently higher [16,17,18,19,22,25,37]. In our study, consistent with the literature, the number of male patients was significantly higher than that of females.
A meta-analysis evaluating hospital admissions due to COPD exacerbations showed that the gender distribution varied widely, with mean ages ranging from 63.0 ± 14.5 to 76.3 ± 10.6 years [30]. Studies by Zetterstein et al. on ICU patients and Grabicki et al. on COPD patients found no differences in the mean age between males and females [16,25]. However, Todorov et al. reported a significantly higher mean age in female ICU patients than in males [75 (64;82) years in women vs. 68 (58;77) years in men, p < 0.001] [28]. In our study, the mean age of females was significantly higher than that of males. The life expectancy at birth in Türkiye is 80 years for women and 74.7 years for men, which may have influenced the results [38].
Comorbidities are common in all stages of COPD, from mild to severe [1]. A study evaluating COPD patients by gender found that the comorbidity burden, based on the CCI, was higher in women with severe and very severe COPD [26]. A study on ICU patients found fewer comorbidities in females than in males (5.4 vs. 6.4, p = 0.002) [26]. Among four studies examining CCI by gender, three found no significant differences [19,39,40], while one reported a higher comorbidity burden in males [25]. In our study, CCI was higher in females than in males. The higher average age in female patients compared to males is believed to impact the CCI, both directly due to age and indirectly due to the increased burden of comorbidities associated with aging.
Cardiovascular diseases are common and significant comorbidities in COPD [1]. The prevalence of systolic and diastolic heart failure in COPD patients ranges from 20% to 70% [41]. COPD is frequently associated with cardiac arrhythmias, which contribute to increased dyspnea [42]. Atrial fibrillation is common in COPD and can exacerbate dyspnea [43]. Hypertension is likely the most common comorbidity in COPD and can significantly impact disease progression [44]. Grabicki et al. found that cardiovascular diseases were more prevalent in females, while coronary artery disease was more common in males [16]. A study conducted in northern Sweden on COPD patients found a higher prevalence of cardiovascular disease in males [45]. Roche et al. found no gender differences in hypertension, ischemic heart disease, or left heart failure [21]. Todorov et al. reported no significant differences between genders in arrhythmias and heart failure [28]. In our study, heart failure, hypertension, atrial fibrillation, increased CTR (a radiological indicator of heart failure), and elevated BNP (a laboratory marker of heart failure) were significantly more common in females. No significant differences were observed between genders in coronary artery disease. It is thought that the higher prevalence of heart failure in women may be related to the frequency of hypertension and atrial fibrillation.
Patients with pulmonary etiologies and increased BMI are considered at risk for ICU admission [46]. Pulmonary causes are the most frequent reasons for hospital admission in patients with an elevated BMI [47]. A study by Kumar et al. on ICU patients found that among patients with a BMI of 30–39, 51.4% were male and 48.6% were female; for a BMI of 40–49, 41.5% were male and 58.5% were female; for a BMI ≥50, 41.9% were male and 58.1% were female [46]. Grabicki et al. found that females had lower BMIs than males [16]. In contrast, Roche et al. reported higher BMIs in females with COPD but no gender differences in the obesity prevalence [21]. In our study, females had significantly higher BMIs than males, and the number of morbidly obese female patients was greater than that of males. A higher age and comorbid disease burden in female patients may contribute to mobility restrictions, which, in turn, may be associated with a higher BMI.
In our study, renal failure and hypothyroidism were significantly more common in females. Matera et al. reported a higher prevalence of renal disease in males [27], and Grabicki et al. found thyroid diseases to be more common in females [16].
When we evaluated the relationship between an increased BMI, hypothyroidism, renal failure, and heart failure, all three conditions were found to be associated with heart failure and an increased heart failure risk. Heart failure often coexists with reduced renal function, and the relationship between the two conditions is bidirectional [47]. Being overweight (BMI ≥ 25 kg/m2) and having obesity (BMI ≥ 30 kg/m2) independently increase the risk of heart failure [48]. Hypothyroidism is also a risk factor for heart failure [49].
Other laboratory parameters significantly higher in females were D-dimer levels assessed on admission and PaCO2 levels measured before discharge. Elevated D-dimer levels are known to correlate with renal failure [50]. The higher PaCO2 levels before discharge in females may be due to the higher BMI and obesity prevalence, making hypercapnia more challenging to control in this group. In males, parameters significantly higher than in females included steroid use and the presence of emphysema. Males and females may exhibit phenotypically different responses to tobacco smoke exposure, with males being more prone to the emphysematous phenotype and females to the airway-dominant phenotype [51]. A review of the literature revealed no studies comparing systemic steroid use between men and women. In our study, the higher prevalence of steroid use in men could be attributed to the prioritization of diuretic therapy in women due to the higher incidence of heart failure as a comorbidity, relegating the anti-inflammatory steroid therapy to secondary importance.
The findings of this study are expected to guide future research. Furthermore, larger, multicenter studies focusing on gender-based comparisons across different age groups would contribute more significantly to clinical practice.

5. Limitations

The study was conducted at a single center. As this was an observational study, only routinely evaluated parameters were examined. Additional tests (e.g., echocardiography, spirometry) could not be performed. Due to the poor general condition of patients at the time of admission, a detailed medical history could not be obtained. Instead, anamnesis was collected from patient relatives and/or previous medical records were reviewed. The smoking history (amount, duration, age of initiation), biomass exposure, GOLD stage, alpha-1 antitrypsin levels, and frequency of exacerbations were not available. Due to the limited sample size, comparisons could not be made based on age groups. Chest radiographs used in the evaluation of CTR were performed with portable devices under intensive care conditions. The weight and height values used in the BMI calculation were either based on information obtained from patients/relatives or estimated. In cases where current data are not sufficient for the parameters used in the calculation of CCI, old records were also examined and included in the calculation.

Strength of the Study

The strength of the study is that it was conducted prospectively in an intensive care unit where a team experienced in NIV application worked and specialized in this field.

6. Conclusions

In our study examining gender-based differences in COPD patients treated with NIV for T2RF, heart failure and risk factors for heart failure were found to be more prominent in female patients. Consistent with the literature, although the number of female patients was lower than that of males, the significantly higher comorbidity burden in females based on CCI scores suggests that medical processes may be more challenging to manage in women. We believe that these findings will contribute to clinical practice and provide clinicians with valuable insights into patient management.

Author Contributions

Conceptualization, T.O., M.Y., M.A., G.E.D., M.Ö.C., and Ç.Ö.; Methodology, T.O., M.Y., M.A., and E.A.; Software, T.O.; Validation, T.O., M.Y., and M.A.; Formal analysis, T.O., M.A., and E.A.; Investigation, T.O., M.Y., E.A., G.E.D., M.Ö.C., and M.D.; Resources, T.O.; Data curation, T.O., M.Y., G.E.D., M.Ö.C., M.D., D.K., and Y.T.Ş.; Writing—original draft, T.O.; Writing—review and editing, T.O., M.Y., M.A., E.A., G.E.D., M.Ö.C., M.D., Ç.Ö., D.K., and Y.T.Ş.; Supervision, T.O.; Project administration, T.O. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Ankara Sanatorium Training and Research Hospital (date: 22 February 2023; No: 2012-KAEK-15/2644).

Informed Consent Statement

Informed consent was obtained from patients prior to data collection.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest.

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Medicina 61 00587 g001
Figure 1. Flowchart of the study. COPD: chronic obstructive pulmonary disease.
Figure 1. Flowchart of the study. COPD: chronic obstructive pulmonary disease.
Medicina 61 00587 g001
Table 1. Comparison of comorbidities, treatments, and hospital stay durations by gender.
Table 1. Comparison of comorbidities, treatments, and hospital stay durations by gender.
GeneralFemaleMalep
n (%)258 (100%)91 (35.3%)167 (64.7%)<0.01
Age69 ± 1072 ± 1268 ± 80.03
Kyphoscoliosis8 (3.1%)5 (5.5%)3 (1.8%)0.102
Morbid obesity26 (10.1%)17 (18.7%)9 (5.4%)<0.001
OSAS13 (5%)6 (6.6%)7 (4.2%)0.400
Hypertension147 (57%)65 (71.4%)82 (49.1%)<0.001
Diabetes Mellitus81 (31.4%)32 (35.2%)49 (29.3%)0.336
Coronary artery disease52 (20.2%)20 (22.0%)32 (19.2%)0.591
Atrial fibrillation39 (15.1%)20 (22.0%)19 (11.4%)0.023
Kidney disease72 (27.9%)33 (36.2%)39 (23.3%)0.027
Neurological disease7 (2.7%)6 (6.6%)1 (0.6%)0.005
Depression/anxiety44 (17.1%)17 (18.7%)27 (16.2%)0.609
Bronchiectasis19 (7.4%)3 (3.3%)16 (9.6%)0.065
Pneumonia17 (6.6%)8 (8.8%)9 (5.4%)0.294
History of previous tuberculosis12 (4.7%)2 (2.2%)10 (6.0%)0.168
Pulmonary embolism16 (6.2%)8 (8.8%)8 (4.8%)0.204
Heart failure124 (48.1%)59 (64.8%)65 (38.9%)<0.001
Lung cancer22 (8.5%)4 (4.4%)18 (10.8%)0.080
Hypothyroidism18 (7.0%)11 (12.8%)7 (4.7%)0.024
Emphysema69 (26.7%)5 (5.5%)64 (38.3%)<0.001
Anemia65 (25.2%)27 (29.7%)38 (22.9%)0.233
Body mass index (Mean ± SD)28 ± 831 ± 927 ± 7<0.001
Charlson comorbidity index (Mean ± SD)5 ± 25 ± 24 ± 10.002
Cardiothoracic ratio (Mean ± SD)0.56 ± 0.090.61 ± 0.070.53 ± 0.09<0.001
Length of stay (Mean ± SD)9 ± 510 ± 79 ± 70.926
Systemic steroid treatment184 (71.3%)55 (60.4%)129 (77.2%)0.004
Antibiotic treatment222 (86%)77 (84.6%)145(68.8%)0.625
Anxiolytic/antidepressant treatment38 (14.7%)14 (15.4%)24 (14.4%)0.827
Nutritional support19 (7.4%)6 (6.6%)13 (7.8%)0.727
Number of patients prescribed BPAPs at home138 (53.5%)50 (54.9%)88 (52.7%)0.730
Number of patients prescribed OCs at homes91 (35.3%)31 (34.1%)60 (35.9%)0.765
OSAS: obstructive sleep apnea syndrome, BPAP: bilevel positive airway pressure, OC: oxygen concentrator.
Table 2. Analysis of laboratory parameters by gender.
Table 2. Analysis of laboratory parameters by gender.
General
258 (100%)		Female
91 (35.3%)		Male
167 (64.7%)		p
Compensation in Hospitalization 0.761
  Compensated (PH = 7.35–7.45) n (%)187 (72.5%)67 (73.6%)120 (71.9%)
  Decompensated (PH < 7.35) n (%)71 (27.5%)24 (26.4%)47 (28.1%)
Admission PH7.29 ± 0.087.28 ± 0.077.29 ± 0.080.686
Discharged PH7.46 ± 0.057.47 ± 0.047.46 ± 0.050.402
Admission PaCO279.1 ± 15.777.5 ± 15.279.8 ± 16.00.239
Discharged PaCO250.4 ± 7.751.6 ± 6.149.8 ± 7.40.036
Admission aHCO337.8 ± 7.737.0 ± 9.038.3 ± 6.90.160
Discharged aHCO336.1 ± 5.337.0 ± 5.335.7 ± 5.30.031
Admission aHCO331.9 ± 7.331.9 ± 8.031.9 ± 6.80.680
Discharged aHCO334.5 ± 4.935.3 ± 4.434.1 ± 5.10.038
Admission aBe8.5 ± 7.68.2 ± 8.48.6 ± 7.10.679
Discharged aBe11.0 ± 5.311.7 ± 4.310.6 ± 5.80.021
Admission sBe11.3 ± 7.910.4 ± 8.711.8 ± 7.30.208
Discharged sBe12.9 ± 6.313 ± 512 ± 60.035
Admission CRP77 ± 8862 ± 7686 ± 940.086
Discharged CRP24 ± 2920 ± 2225 ± 320.792
Admission BUN59 ± 3466 ± 3555 ± 330.006
Discharged BUN52 ± 2552 ± 2352 ± 250.848
Admission creatinine1.15 ± 0.591.16 ± 0.521.15 ± 0.630.591
Discharged creatinine0.94 ± 0.500.87 ± 0.270.98 ± 0.590.136
Admission sodium138.6 ± 4.8139.0 ± 4.2138.4 ± 5.10.500
Discharged sodium138.6 ± 3.4139.4 ± 3.4138.2 ± 3.40.003
Admission potassium4.58 ± 0.784.56 ± 0.724.60 ± 0.810.237
Discharged potassium4.19 ± 0.634.14 ± 0.584.21 ± 0.670.229
Admission chloride96.5 ± 6.796.3 ± 6.396.7 ± 7.00.399
Discharged chloride96.1 ± 4.395.9 ± 4.796.1 ± 4.10.683
Admission magnesium2.03 ± 0.352.00 ± 0.352.04 ± 0.360.636
Discharge magnesium1.95 ± 0.241.91 ± 0.261.96 ± 0.220.183
Admission calcium8.76 ± 0.768.67 ± 0.858.81 ± 0.700.594
Discharge calcium8.69 ± 0.608.73 ± 0.618.67 ± 0.600.501
Admission albumin3.50 ± 0.523.48 ± 0.503.51 ± 0.540.518
Discharge albumin3.16 ± 0.453.14 ± 0.393.17 ± 0.480.465
Admission leukocyte10.92 ± 4.3911.01 ± 4.2710.87 ± 4.460.753
Dischage leukocyte9.08 ± 3.418.68 ± 2.919.30 ± 3.640.294
Admission lymphocyte1.27 ± 1.061.36 ± 0.981.22 ± 1.100.127
Discharge lymphocyte1.36 ± 1.391.29 ± 0.731.40 ± 1.650.680
Admission monocyte0.611 ± 0.2540.601 ± 0.3520.616 ± 0.3760.695
Discharge monocyte0.589 ± 0.2540.573 ± 0.2340.598 ± 0.2650.618
Admission neutrophil8.81 ± 3.948.78 ± 3.918.83 ± 3.970.827
Discharge neutrophil7.05 ± 2.966.62 ± 2.767.29 ± 3.050.119
Admission eosinophil0.082 ± 0.1850.073 ± 0.1180.087 ± 0.2130.938
Discharge eosinophil0.123 ± 0.1540.144 ± 0.1910.111 ± 0.1290.485
Admission basophil0.037 ± 0.0350.036 ± 0.0260.038 ± 0.0390.599
Discharge basophil0.028 ± 0.0220.029 ± 0.0240.027 ± 0.0210.493
Admission hemoglobin13.2 ± 2.612.1 ± 2.313.8 ± 2.6<0.001
Discharge hemoglobin12.2 ± 2.611.4 ± 2.212.7 ± 2.7<0.001
Admission platelet244 ± 92253 ± 94239 ± 910.162
Discharge platelet233 ± 87229 ± 90234 ± 850.456
Admission procalcitonin0.81 ± 4.900.35 ± 0.991.07 ± 6.060.510
Discharge procalcitonin0.11 ± 0.270.10 ± 0.240.11 ± 0.280.822
Admission D-dimer2497 ± 46673535 ± 64111933 ± 32550.036
Admission troponin347 ± 1660249 ± 697401 ± 20050.702
Admission BNP355 ± 519469 ± 603294 ± 4580.004
Admission T40.98 ± 0.230.95 ± 0.210.99 ± 0.240.381
Admission TSH2.05 ± 9.323.42 ± 151.27 ± 20.640
PaCO2: partial arterial carbon dioxide pressure, aHCO3: actual bicarbonate, aBe: actual base excess, sBe: standard base excess, BNP: brain natriuretic peptide, TSH: thyroid-stimulating hormone.
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Ozdemir, T.; Yıldız, M.; Arı, M.; Arı, E.; Eraslan Doğanay, G.; Cırık, M.Ö.; Doğancı, M.; Özdilekcan, Ç.; Kızılgöz, D.; Şipit, Y.T. Gender-Based Differences in COPD Patients with Type 2 Respiratory Failure—Impact on Clinical Practice. Medicina 2025, 61, 587. https://doi.org/10.3390/medicina61040587

AMA Style

Ozdemir T, Yıldız M, Arı M, Arı E, Eraslan Doğanay G, Cırık MÖ, Doğancı M, Özdilekcan Ç, Kızılgöz D, Şipit YT. Gender-Based Differences in COPD Patients with Type 2 Respiratory Failure—Impact on Clinical Practice. Medicina. 2025; 61(4):587. https://doi.org/10.3390/medicina61040587

Chicago/Turabian Style

Ozdemir, Tarkan, Murat Yıldız, Maşide Arı, Emrah Arı, Güler Eraslan Doğanay, Mustafa Özgür Cırık, Melek Doğancı, Çiğdem Özdilekcan, Derya Kızılgöz, and Yusuf Tuğrul Şipit. 2025. "Gender-Based Differences in COPD Patients with Type 2 Respiratory Failure—Impact on Clinical Practice" Medicina 61, no. 4: 587. https://doi.org/10.3390/medicina61040587

APA Style

Ozdemir, T., Yıldız, M., Arı, M., Arı, E., Eraslan Doğanay, G., Cırık, M. Ö., Doğancı, M., Özdilekcan, Ç., Kızılgöz, D., & Şipit, Y. T. (2025). Gender-Based Differences in COPD Patients with Type 2 Respiratory Failure—Impact on Clinical Practice. Medicina, 61(4), 587. https://doi.org/10.3390/medicina61040587

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