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

Lavienraj Premraj; Natasha Anne Weaver; Syed Ameen Ahmad; Nicole White; Glenn Whitman; Rakesh Arora; Denise Battaglini; Jonathon Fanning; Heidi Dalton; Jacky Suen; Gianluigi Li Bassi; John F Fraser; Chiara Robba; Matthew Griffee; Sung-Min Cho; COVID-19 CCC investigators

doi:10.1016/j.hrtlng.2024.09.001

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

Heart Lung. 2024 Nov-Dec:68:373-380. doi: 10.1016/j.hrtlng.2024.09.001. Epub 2024 Sep 10.

Authors

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Griffith University School of Medicine, Gold Coast, Australia.
² School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
³ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Queensland University of Technology, Faculty of Health, Brisbane, Australia.
⁵ Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ 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.
⁷ IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science and Diagnostic Integrated, University of Genoa, Italy.
⁸ 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.
⁹ Inova Fairfax medical campus, Fairfax, VA, USA.
¹⁰ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia.
¹¹ 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.
¹² 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.
¹³ Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
¹⁴ 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: [email protected].

PMID: 39260269
DOI: 10.1016/j.hrtlng.2024.09.001

Abstract

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.

Keywords: ARDS; COVID-19; ECMO; Mechanical Ventilation; Sex.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
COVID-19* / complications
COVID-19* / epidemiology
COVID-19* / mortality
COVID-19* / therapy
Critical Care / methods
Critical Care / statistics & numerical data
Critical Illness*
Female
Hospital Mortality* / trends
Humans
Intensive Care Units* / statistics & numerical data
Male
Middle Aged
Retrospective Studies
SARS-CoV-2
Severity of Illness Index
Sex Factors