TY - JOUR
T1 - Caractéristiques des traitements en fonction du sexe et résultats de mortalité à 30 jours des patients atteints de COVID-19 gravement malades de plus de 70 ans—résultats de l’étude prospective COVIP
AU - the COVIP Study Group
AU - Wolff, Georg
AU - Wernly, Bernhard
AU - Flaatten, Hans
AU - Fjølner, Jesper
AU - Bruno, Raphael Romano
AU - Artigas, Antonio
AU - Pinto, Bernardo Bollen
AU - Schefold, Joerg C.
AU - Kelm, Malte
AU - Binneboessel, Stephan
AU - Baldia, Philipp
AU - Beil, Michael
AU - Sivri, Sigal
AU - van Heerden, Peter Vernon
AU - Szczeklik, Wojciech
AU - Elhadi, Muhammed
AU - Joannidis, Michael
AU - Oeyen, Sandra
AU - Flamm, Maria
AU - Zafeiridis, Tilemachos
AU - Marsh, Brian
AU - Andersen, Finn H.
AU - Moreno, Rui
AU - Boumendil, Ariane
AU - De Lange, Dylan W.
AU - Guidet, Bertrand
AU - Leaver, Susannah
AU - Jung, Christian
N1 - Funding Information:
The study is supported in France by a grant from Fondation Assistance Publique-Hôpitaux de Paris pour la recherche. In Norway, the study is supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union's Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. The first author was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf (No. 2018-32 for a Clinician Scientist Track).
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/11
Y1 - 2022/11
N2 - Purpose: Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort. Methods: We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality. Results: A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P < 0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P < 0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P < 0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16). Conclusion: In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality. Study registration: www.ClinicalTrials.gov (NCT04321265); registered 25 March 2020).
AB - Purpose: Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort. Methods: We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality. Results: A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P < 0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P < 0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P < 0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16). Conclusion: In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality. Study registration: www.ClinicalTrials.gov (NCT04321265); registered 25 March 2020).
KW - COVID
KW - COVIP
KW - critical illness
KW - elderly
KW - mortality
KW - sex
UR - http://www.scopus.com/inward/record.url?scp=85135863413&partnerID=8YFLogxK
U2 - 10.1007/s12630-022-02304-2
DO - 10.1007/s12630-022-02304-2
M3 - Article
C2 - 35945477
AN - SCOPUS:85135863413
SN - 0832-610X
VL - 69
SP - 1390
EP - 1398
JO - Canadian Journal of Anesthesia
JF - Canadian Journal of Anesthesia
IS - 11
ER -