Sex Differences in Clinical Characteristics and Outcomes of Patients with SARS-CoV-2-Infection Admitted to Intensive Care Units in Austria.

IMPORTANCE

A male predominance is reported in hospitalised patients with COVID-19 alongside a higher mortality rate in men compared to women.

OBJECTIVE

To assess if the reported sex bias in the COVID-19 pandemic is validated by analysis of a subset of patients with severe disease.

DESIGN

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.

SETTING

We studied the characteristics and outcomes of patients admitted to intensive care units (ICUs) in Austria.

PARTICIPANTS

5118 patients admitted to the ICU in Austria with a COVID-19 diagnosis in 03/2020-03/2021.

EXPOSURES

Demographic and clinical characteristics, vital signs and laboratory tests, comorbidities, and management of patients admitted to ICUs were analysed for possible sex differences.

MAIN OUTCOMES AND MEASURES

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.

RESULTS

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)).

CONCLUSIONS AND RELEVANCE

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.