Sex differences in the outcome of critically Ill patients with COVID-19 - An international multicenter critical care consortium study.

ARDS COVID-19 ECMO Mechanical Ventilation Sex

Journal

Heart & lung : the journal of critical care
ISSN: 1527-3288
Titre abrégé: Heart Lung
Pays: United States
ID NLM: 0330057

Informations de publication

Date de publication:
10 Sep 2024
Historique:
received: 17 07 2024
revised: 27 08 2024
accepted: 02 09 2024
medline: 12 9 2024
pubmed: 12 9 2024
entrez: 11 9 2024
Statut: aheadofprint

Résumé

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. 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. 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). 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.

Sections du résumé

BACKGROUND 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 OBJECTIVE
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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1016/j.hrtlng.2024.09.001 PMID: 39260269
pubmed: 39260269
pii: S0147-9563(24)00160-2
doi: 10.1016/j.hrtlng.2024.09.001
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

373-380

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest We, the authors of the manuscript “Sex Differences in The Outcome of Critically Ill COVID-19 Patients - An International Multicentre COVID-19 Critical Care Consortium Study” declare that we have no competing interests in any of the categories listed: employment, consultancies, stock ownership, honoraria, paid expert testimony, patient applications/registrations (as listed on the journal website). Our funding statement as presented in the manuscript is accurate as of the submission date and presents no conflict of interests.

Auteurs

Lavienraj Premraj (L)

Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Griffith University School of Medicine, Gold Coast, Australia.

Natasha Anne Weaver (NA)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.

Syed Ameen Ahmad (SA)

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Nicole White (N)

Queensland University of Technology, Faculty of Health, Brisbane, Australia.

Glenn Whitman (G)

Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Rakesh Arora (R)

Cardiac Science Program, St Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada; University of Manitoba, Canada; Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.

Denise Battaglini (D)

IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science and Diagnostic Integrated, University of Genoa, Italy.

Jonathon Fanning (J)

Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia; Nuffield Department of Population Health, University of Oxford, UK; St Andrew's War Memorial Hospital, UnitingCare, Australia.

Heidi Dalton (H)

Inova Fairfax medical campus, Fairfax, VA, USA.

Jacky Suen (J)

Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia.

Gianluigi Li Bassi (G)

Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Queensland University of Technology, Faculty of Health, Brisbane, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia.

John F Fraser (JF)

Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Queensland University of Technology, Faculty of Health, Brisbane, Australia; Department of Surgical Science and Diagnostic Integrated, University of Genoa, Italy; St Andrew's War Memorial Hospital, UnitingCare, Australia.

Chiara Robba (C)

IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science and Diagnostic Integrated, University of Genoa, Italy.

Matthew Griffee (M)

Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.

Sung-Min Cho (SM)

Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: csungmi1@jhmi.edu.

Classifications MeSH