Lavienraj Premraj BMsc , Natasha Anne Weaver PhD , Syed Ameen Ahmad BSc , Nicole White PhD , Glenn Whitman MD , Rakesh Arora MD , Denise Battaglini MD , Jonathon Fanning PhD , Heidi Dalton MD , Jacky Suen BSc, PhD , Gianluigi Li Bassi MD , John F. Fraser MBChB , Chiara Robba PhD , Matthew Griffee MD , Sung-Min Cho MHS, DO , COVID-19 CCC investigators
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The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown.</p></div><div><h3>Objectives</h3><p>To determine the effects of sex on ICU mortality in patients with COVID-19</p></div><div><h3>Methods</h3><p>This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay.</p></div><div><h3>Results</h3><p>Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, <em>p</em> < 0.01) and obese (39% vs. 30 %, <em>p</em> < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55).</p></div><div><h3>Conclusion</h3><p>Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. Ultimately, the hazard of death was moderately elevated in males compared to females despite greater PE and cardiac arrest.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 373-380"},"PeriodicalIF":2.4000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001602/pdfft?md5=2bb3d4feb84a5337323b3a081a70f8ef&pid=1-s2.0-S0147956324001602-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Sex differences in the outcome of critically Ill patients with COVID-19 - An international multicenter critical care consortium study\",\"authors\":\"Lavienraj Premraj BMsc , Natasha Anne Weaver PhD , Syed Ameen Ahmad BSc , Nicole White PhD , Glenn Whitman MD , Rakesh Arora MD , Denise Battaglini MD , Jonathon Fanning PhD , Heidi Dalton MD , Jacky Suen BSc, PhD , Gianluigi Li Bassi MD , John F. Fraser MBChB , Chiara Robba PhD , Matthew Griffee MD , Sung-Min Cho MHS, DO , COVID-19 CCC investigators\",\"doi\":\"10.1016/j.hrtlng.2024.09.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Sex differences in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) susceptibility, illness severity, and hospital course are widely acknowledged. The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown.</p></div><div><h3>Objectives</h3><p>To determine the effects of sex on ICU mortality in patients with COVID-19</p></div><div><h3>Methods</h3><p>This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay.</p></div><div><h3>Results</h3><p>Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, <em>p</em> < 0.01) and obese (39% vs. 30 %, <em>p</em> < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55).</p></div><div><h3>Conclusion</h3><p>Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. 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Sex differences in the outcome of critically Ill patients with COVID-19 - An international multicenter critical care consortium study
Background
Sex differences in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) susceptibility, illness severity, and hospital course are widely acknowledged. The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown.
Objectives
To determine the effects of sex on ICU mortality in patients with COVID-19
Methods
This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay.
Results
Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, p < 0.01) and obese (39% vs. 30 %, p < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55).
Conclusion
Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. Ultimately, the hazard of death was moderately elevated in males compared to females despite greater PE and cardiac arrest.
期刊介绍：
Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders.
The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.
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