Kautzky-Willer Alexandra, Kaleta Michaela, Lindner Simon D, Leutner Michael, Thurner Stefan, Klimek Peter
Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Gender Institute, A-3571 Gars am Kamp, Austria.
J Pers Med. 2022 Mar 23;12(4):517. doi: 10.3390/jpm12040517.
A male predominance is reported in hospitalised patients with COVID-19 alongside a higher mortality rate in men compared to women.
To assess if the reported sex bias in the COVID-19 pandemic is validated by analysis of a subset of patients with severe disease.
A nationwide retrospective cohort study was performed using the Austrian National COVID Database. We performed a sex-specific Lasso regression to select the covariates best explaining the outcomes of mechanical ventilation and death using variables known before ICU admission. We use logistic regression to construct a sex-specific "risk score" for the outcomes using these variables.
We studied the characteristics and outcomes of patients admitted to intensive care units (ICUs) in Austria.
5118 patients admitted to the ICU in Austria with a COVID-19 diagnosis in 03/2020-03/2021.
Demographic and clinical characteristics, vital signs and laboratory tests, comorbidities, and management of patients admitted to ICUs were analysed for possible sex differences.
The aim was to define risk scores for mechanical ventilation and mortality for each sex to provide better sex-sensitive management and outcomes in the future.
We found balanced accuracies between 55% and 65% to predict the outcomes. Regarding outcome death, we found that the risk score for pre-ICU variables increases with age, renal insufficiency (f: OR 1.7(2), m: 1.9(2)) and decreases with observance as admission cause (f: OR 0.33(5), m: 0.36(5)). Additionally, the risk score for females also includes respiratory insufficiency (OR 2.4(4)) while heart failure for males only (OR 1.5(1)).
Better knowledge of how sex influences COVID-19 outcomes at ICUs will have important implications for the ongoing pandemic's clinical care and management strategies. Identifying sex-specific features in individuals with COVID-19 and fatal consequences might inform preventive strategies and public health services.
据报道，新冠肺炎住院患者中男性占比更高，且男性死亡率高于女性。
通过对一部分重症患者进行分析，评估新冠肺炎疫情中所报道的性别偏见是否得到验证。
使用奥地利国家新冠肺炎数据库进行了一项全国性回顾性队列研究。我们进行了性别特异性套索回归，以使用重症监护病房（ICU）入院前已知的变量来选择最能解释机械通气和死亡结果的协变量。我们使用逻辑回归，利用这些变量为结果构建性别特异性“风险评分”。
我们研究了奥地利重症监护病房（ICU）收治患者的特征和结果。
2020年3月至2021年3月期间，奥地利5118例确诊新冠肺炎并入住ICU的患者。
分析了入住ICU患者的人口统计学和临床特征、生命体征和实验室检查、合并症以及治疗情况，以寻找可能存在的性别差异。
目的是为每种性别定义机械通气和死亡率的风险评分，以便未来提供更具性别敏感性的管理和改善结局。
我们发现预测结果的平衡准确率在55%至65%之间。关于死亡结局，我们发现ICU前变量的风险评分随年龄、肾功能不全增加（女性：比值比1.7(2)，男性：1.9(2)），并随因观察而入院的情况降低（女性：比值比0.33(5)，男性：0.36(5)）。此外，女性的风险评分还包括呼吸功能不全（比值比2.4(4)），而男性仅包括心力衰竭（比值比1.5(1)）。
更好地了解性别如何影响ICU中新冠肺炎的结局，将对当前疫情的临床护理和管理策略产生重要影响。识别新冠肺炎患者中具有性别特异性的特征及其致命后果，可能为预防策略和公共卫生服务提供参考。
