Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/36882
Title: Better COVID-19 Intensive Care Unit survival in females, independent of age, disease severity, comorbidities, and treatment
Authors: Meijs, Daniek A. M.
van Bussel, Bas C. T.
STESSEL, Bjorn 
Mehagnoul-Schipper, Jannet
Hana, Anisa
Scheeren, Clarissa I. E.
Peters, Sanne A. E.
van Mook, Walther N. K. A.
van der Horst, Iwan C. C.
Marx , Gernot
MESOTTEN, Dieter 
Ghossein-Doha, Chahinda
Heijnen, Nanon F. L.
Bickenbach, Johannes
van der Woude, Meta C. E.
Raafs, Anne
van Kuijk, Sander M. J.
Smits, Luc J. M.
Janssen, Emma B. N. J.
Pierlet, Noella
Goethuys , Ben
Bruggen, Jonas
Vermeiren, Gilles
Vervloessem, Hendrik
Mulder, Mark M. G.
Koelmann, Marcel
Bels, Julia L. M.
Bormans-Russell, Laura
Florack, Micheline C. D. M.
BOER, Willem 
VANDER LAENEN, Margot 
Issue Date: 2022
Publisher: NATURE PORTFOLIO
Source: Scientific Reports, 12 (1) (Art N° 734)
Abstract: Although male Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients have higher Intensive Care Unit (ICU) admission rates and a worse disease course, a comprehensive analysis of female and male ICU survival and underlying factors such as comorbidities, risk factors, and/or anti-infection/inflammatory therapy administration is currently lacking. Therefore, we investigated the association between sex and ICU survival, adjusting for these and other variables. In this multicenter observational cohort study, all patients with SARS-CoV-2 pneumonia admitted to seven ICUs in one region across Belgium, The Netherlands, and Germany, and requiring vital organ support during the first pandemic wave were included. With a random intercept for a center, mixed-effects logistic regression was used to investigate the association between sex and ICU survival. Models were adjusted for age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, comorbidities, and anti-infection/inflammatory therapy. Interaction terms were added to investigate effect modifications by sex with country and sex with obesity. A total of 551 patients (29% were females) were included. Mean age was 65.4 +/- 11.2 years. Females were more often obese and smoked less frequently than males (p-value 0.001 and 0.042, respectively). APACHE II scores of females and males were comparable. Overall, ICU mortality was 12% lower in females than males (27% vs 39% respectively, p-value < 0.01) with an odds ratio (OR) of 0.62 (95%CI 0.39-0.96, p-value 0.032) after adjustment for age and APACHE II score, 0.63 (95%CI 0.40-0.99, p-value 0.044) after additional adjustment for comorbidities, and 0.63 (95%CI 0.39-0.99, p-value 0.047) after adjustment for anti-infection/inflammatory therapy. No effect modifications by sex with country and sex with obesity were found (p-values for interaction > 0.23 and 0.84, respectively). ICU survival in female SARS-CoV-2 patients was higher than in male patients, independent of age, disease severity, smoking, obesity, comorbidities, anti-infection/inflammatory therapy, and country. Sex-specific biological mechanisms may play a role, emphasizing the need to address diversity, such as more sex-specific prediction, prognostic, and therapeutic approach strategies.
Notes: Meijs, DAM (corresponding author), Maastricht Univ, Med Ctr, Dept Intens Care Med, Maastricht UMC, P Debyelaan 25, NL-6229 HX Maastricht, Netherlands.; Meijs, DAM (corresponding author), Laurentius Ziekenhuis, Dept Intens Care Med, Roermond, Netherlands.
daniek.meijs@mumc.nl
Keywords: Aged;COVID-19;Female;Hospitalization;Humans;Intensive Care Units;Male;Middle Aged;Retrospective Studies;Risk Factors;Severity of Illness Index;Pandemics
Document URI: http://hdl.handle.net/1942/36882
ISSN: 2045-2322
e-ISSN: 2045-2322
DOI: 10.1038/s41598-021-04531-x
ISI #: WOS:000742753500018
Rights: The Author(s) 2022 Open Access Tis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Te images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Category: A1
Type: Journal Contribution
Validations: ecoom 2023
Appears in Collections:Research publications

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