Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

Mi Yang; Yan Yang; Liju Liu; Di Kong; Min Xu; Xincheng Huang; Cheng Luo; Guocheng Zhao; Xiangyang Zhang; Yan Huang; Yunzhong Tu; Zezhi Li

doi:10.3389/fpsyt.2023.1127262

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

Front Psychiatry. 2023 Feb 14:14:1127262. doi: 10.3389/fpsyt.2023.1127262. eCollection 2023.

Authors

Mi Yang^{1

2

3}, Yan Yang¹, Liju Liu³, Di Kong¹, Min Xu¹, Xincheng Huang¹, Cheng Luo¹, Guocheng Zhao¹, Xiangyang Zhang⁴, Yan Huang⁵, Yunzhong Tu^{6

7}, Zezhi Li^{6

7}

Affiliations

¹ Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China.
² The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.
³ School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.
⁴ CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
⁵ Department of Psychiatry, Chongqing Mental Health Center, Chongqing, China.
⁶ Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
⁷ Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.

Abstract

Background: Sex differences may be presented in the clinical features or symptoms of schizophrenia patients but also affect the occurrence of hospital-acquired pneumonia (HAP). Modified electroconvulsive therapy (mECT) is a common treatment method for schizophrenia, used in combination with antipsychotics. This retrospective research explores the sex difference in HAP affecting patients with schizophrenia who have received mECT treatment during hospitalization.

Methods: We included schizophrenia inpatients treated with mECT and antipsychotics between January 2015 and April 2022. Blood-related and demographic data collected on admission were analyzed. Influencing factors of HAP in male and female groups were assessed separately.

Results: A total of 951 schizophrenia patients treated with mECT were enrolled in the study, including 375 males and 576 females, of which 62 patients experienced HAP during hospitalization. The risk period of HAP in these patients was found to be the first day after each mECT treatment and the first three sessions of mECT treatment. Statistically significant differences in the incidence of HAP were identified in male vs. female groups, with an incidence in men about 2.3 times higher than that in women (P < 0.001). Lower total cholesterol (Z = -2.147, P = 0.032) and the use of anti-parkinsonian drugs (χ² = 17.973, P < 0.001) were found to be independent risk factors of HAP in male patients, while lower lymphocyte count (Z = -2.408, P = 0.016), hypertension (χ² = 9.096, P = 0.003), and use of sedative-hypnotic drugs (χ² = 13.636, P < 0.001) were identified in female patients.

Conclusion: Influencing factors of HAP in schizophrenia patients treated with mECT have gender differences. The first day after each mECT treatment and the first three sessions of mECT treatment were identified to have the greatest risk for HAP development. Therefore, it would be imperative to monitor clinical management and medications during this period according to these gender differences.

Keywords: hospital-acquired pneumonia; modified electroconvulsive therapy; non-antipsychotics; schizophrenia; sex difference.

Grants and funding

This research was funded by National Natural Science Foundation of China (62073058), Chengdu Science and Technology Bureau (2022-YF05-01867-SN), Chengdu Municipal Health Commission (2021057), the Science and Technology Plan Project of Guangdong Province (2019B030316001), Guangzhou Municipal Key Discipline in Medicine (2021–2023), Open Project Program of State Key Laboratory of Virtual Reality Technology and Systems, Beihang University (No. VRLAB2022 B02), and Shanghai Key Laboratory of Psychotic Disorders Open Grant (21-K03).