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

Autor: Premraj L; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Griffith University School of Medicine, Gold Coast, Australia., Weaver NA; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia., Ahmad SA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., White N; Queensland University of Technology, Faculty of Health, Brisbane, Australia., 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., 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., Battaglini D; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science and Diagnostic Integrated, University of Genoa, Italy., 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., Dalton H; Inova Fairfax medical campus, Fairfax, VA, USA., Suen J; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia., 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., 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., Robba C; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science and Diagnostic Integrated, University of Genoa, Italy., Griffee M; Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA., 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.
Jazyk: angličtina
Zdroj: Heart & lung : the journal of critical care [Heart Lung] 2024 Nov-Dec; Vol. 68, pp. 373-380. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1016/j.hrtlng.2024.09.001
Abstrakt: 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.
Competing Interests: 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.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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