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Long-term outcome after intensive care for COVID-19: differences between men and women-a nationwide cohort study
Erik Zettersten1,2, Lars Engerström3,4,5,6, Max Bell7,8
1Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden. erik.zettersten@sll.se.
Insights
Men with COVID-19 admitted to intensive care face a higher risk of long-term mortality compared to women. This study highlights sex-based differences in COVID-19 outcomes, emphasizing the need for further research into underlying causes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Long-term outcomes for COVID-19 patients remain unclear, particularly concerning sex-based differences.
- Men appear to experience more severe COVID-19 disease courses than women.
Purpose of the Study:
- To analyze the long-term outcomes (beyond 90 days) of intensive care unit (ICU) patients with COVID-19.
- To investigate sex-specific differences in mortality among COVID-19 ICU patients.
Main Methods:
- A nationwide cohort study of 2354 adult COVID-19 patients admitted to Swedish ICUs between March and June 2020.
- Patients were followed until October 2020, with Cox and logistic regression analyses used to assess mortality associated with sex and other clinical variables.
Main Results:
- Male sex was significantly associated with increased long-term mortality (HR 1.28) even after adjustments.
- Ninety-day mortality was 28.2% for men and 23.4% for women. Few deaths occurred after 90 days.
- Age, COPD/asthma, immune deficiency, malignancy, SAPS3 score, and admission month were also associated with mortality.
Conclusions:
- Men admitted to the ICU with COVID-19 face a higher risk of poor long-term outcomes compared to women.
- The biological mechanisms driving these observed sex differences in COVID-19 outcomes require further investigation.
Background:
Questions remain about long-term outcome for COVID-19 patients in general, and differences between men and women in particular given the fact that men seem to suffer a more dramatic course of the disease. We therefore analysed outcome beyond 90 days in ICU patients with COVID-19, with special focus on differences between men and women.
Methods:
We identified all patient ≥ 18 years with COVID-19 admitted between March 6 and June 30, 2020, in the Swedish Intensive Care Registry. Patients were followed until death or study end-point October 22, 2020. Association with patient sex and mortality, in addition to clinical variables, was estimated using Cox regression. We also performed a logistic regression model estimating factors associated with 90-day mortality.
Results:
In total, 2354 patients with COVID-19 were included. Four patients were still in the ICU at study end-point. Median follow-up time was 183 days. Mortality at 90-days was 26.9%, 23.4% in women and 28.2% in men. After 90 days until end of follow-up, only 11 deaths occurred. On multivariable Cox regression analysis, male sex (HR 1.28, 95% CI 1.06-1.54) remained significantly associated with mortality even after adjustments. Additionally, age, COPD/asthma, immune deficiency, malignancy, SAPS3 and admission month were associated with mortality. The logistic regression model of 90-day mortality showed almost identical results.
Conclusions:
In this nationwide study of ICU patients with COVID-19, men were at higher risk of poor long-term outcome compared to their female counterparts. The underlying mechanisms for these differences are not fully understood and warrant further studies.
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