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

Abstract

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.

Neuropeptide stimulation of physiological and immunological responses in precision‐cut lung slices

“…Respiratory inflammatory diseases are more common in females compared to males; however, males are more susceptible to diseases such as COVID‐19 and pneumonia (Chamekh et al., 2017; Klein et al., 2001). Patients presenting with similar symptoms of the same age and fitness can have drastically different outcomes depending upon their sex (Hong et al., 2016; Kautzky‐Willer et al., 2022; McNicholas et al., 2019; Tejpal et al., 2021; Trigueros et al., 2019; Ursin & Klein, 2021). In the lung, sex‐dependent neural differences include changes in acetylcholine release and neuromuscular function, regulation of airway constriction, ciliary clearance, and mucus secretion (Carey, Card, Voltz, Germolec, et al., 2007; Dominelli & Molgat‐Seon, 2022; Fuseini & Newcomb, 2017; Han et al., 2018; LoMauro & Aliverti, 2018; Townsend et al., 2012).…”

Molecular and cellular mechanisms involved in tissue-specific metabolic modulation by SARS-CoV-2

“…More studies addressing the effects of dyslipidemia and lipid metabolism in COVID-19 pathology are truthfully necessary. There are few studies that establish the relationship between metabolism and age or sex, most of which are directed to the risk of infections (Chew et al, 2021;Kautzky-Willer et al, 2022). It is important to point out that metabolic alterations are different in the acute stage of SARS-CoV-2 infection and after it, as for example during long-COVID-19 (Sykes et al, 2021).…”