Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Nov;69(11):1390-1398.
doi: 10.1007/s12630-022-02304-2. Epub 2022 Aug 9.

Sex-specific treatment characteristics and 30-day mortality outcomes of critically ill COVID-19 patients over 70 years of age-results from the prospective COVIP study

Georg Wolff  1 , Bernhard Wernly  2 , Hans Flaatten  3 , Jesper Fjølner  4 , Raphael Romano Bruno  1 , Antonio Artigas  5 , Bernardo Bollen Pinto  6 , Joerg C Schefold  7 , Malte Kelm  1 , Stephan Binneboessel  1 , Philipp Baldia  1 , Michael Beil  8 , Sigal Sivri  8 , Peter Vernon van Heerden  9 , Wojciech Szczeklik  10 , Muhammed Elhadi  11 , Michael Joannidis  12 , Sandra Oeyen  13 , Maria Flamm  14 , Tilemachos Zafeiridis  15 , Brian Marsh  16 , Finn H Andersen  17   18 , Rui Moreno  19 , Ariane Boumendil  20 , Dylan W De Lange  21 , Bertrand Guidet  20 , Susannah Leaver  22 , Christian Jung  23   24 ; COVIP Study Group
Affiliations
Multicenter Study

Sex-specific treatment characteristics and 30-day mortality outcomes of critically ill COVID-19 patients over 70 years of age-results from the prospective COVIP study

Georg Wolff et al. Can J Anaesth. 2022 Nov.

Abstract
in English, French

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).

RéSUMé: OBJECTIF: Les patients âgés gravement malades atteints de la COVID-19 ont été les plus vulnérables pendant la pandémie actuelle, les hommes étant plus sujets à l’hospitalisation et aux maladies graves que les femmes. Nous avons cherché à explorer les différences spécifiques au sexe dans le traitement et les devenirs après l’admission à l’unité de soins intensifs (USI) dans cette cohorte. MéTHODE: Nous avons effectué une analyse spécifique au sexe chez des patients gravement malades âgés de ≥ 70 ans atteints de COVID-19 qui ont été inclus dans l’étude prospective multicentrique internationale COVIP. Tous les patients ont été analysés pour connaître les détails de leur admission à l’USI et les caractéristiques de leur traitement. Nous avons réalisé une analyse de régression ajustée à plusieurs niveaux pour élucider les associations entre le sexe et la mortalité à 30 jours. RéSULTATS: Au total, 3159 patients (69,8 % d’hommes, 30,2 % de femmes; âge médian, 75 ans) ont été inclus. Les patients de sexe masculin étaient significativement plus en forme que les patientes, tel que déterminé par l’échelle de fragilité clinique (bonne santé, 67 % vs 54 %; vulnérables, 14 % vs 19 %; fragiles, 19 % vs 27 %; P < 0,001). Les patients de sexe masculin ont plus souvent bénéficié d’une trachéostomie (20 % vs 14 %; rapport de cotes [RC], 1,57; P < 0,001), d’un traitement vasopresseur (69 % vs 62 %; RC, 1,25; P = 0,02) et d’un traitement substitutif de l’insuffisance rénale (17 % vs 11 %; RC, 1,96; P < 0,001). Il n’y avait aucune différence en matière de ventilation mécanique, de limites des traitements de maintien en vie et de mortalité brute à 30 jours (50 % d’hommes vs 49 % de femmes; RC, 1,11; P = 0,19), ce qui est demeuré le cas après ajustement pour tenir compte de la gravité de la maladie, de la fragilité, de l’âge et des limites du traitement (RC, 1,17 ; intervalle de confiance à 95 %, 0,94 à 1,45; P = 0,16). CONCLUSION: Dans cette analyse des caractéristiques de traitement spécifiques au sexe et des résultats de mortalité à 30 jours des patients gravement malades atteints de COVID-19 de ≥ 70 ans, nous avons noté un nombre plus élevé de trachéotomies et de traitements substitutifs de l’insuffisance rénale chez les hommes vs les femmes, mais aucune association significative entre le sexe des patients et la mortalité à 30 jours. ENREGISTREMENT DE L’éTUDE: www.ClinicalTrials.gov (NCT04321265); enregistré le 25 mars 2020.

Keywords: COVID; COVIP; critical illness; elderly; mortality; sex.

PubMed Disclaimer

Conflict of interest statement

All authors declare no support from any industry for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. Joerg C. Schefold reports grants (full departmental disclosure) from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Philips Medical, Phagenesis Ltd, Prolong Pharmaceuticals, and Nycomed outside the submitted work. The money went into departmental funds. No personal financial gain applied.

Comment in

Similar articles

See all similar articles

Cited by

  • In reply: Sex-specific outcomes in COVID-19: missing pieces of the puzzle.
    Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, Jung C; COVIP study group. Wolff G, et al. Can J Anaesth. 2023 Jun;70(6):1110-1112. doi: 10.1007/s12630-023-02470-x. Epub 2023 May 10. Can J Anaesth. 2023. PMID: 37165131 Free PMC article. No abstract available.
  • Sex-specific outcomes in COVID-19: missing pieces of the puzzle.
    Magoon R, Choudhary N. Magoon R, et al. Can J Anaesth. 2023 Jun;70(6):1108-1109. doi: 10.1007/s12630-023-02469-4. Epub 2023 May 10. Can J Anaesth. 2023. PMID: 37165130 Free PMC article. No abstract available.
  • Role of Frailty Index-Laboratory to predict COVID-19 mortality: a prospective study.
    De Vita E, Veronese N, Guido G, Frallonardo L, Cotugno S, Cesari GM, Cibelli M, Vigna A, Capruzzi D, Fiorella M, Santoro CR, Brindicci G, Di Gennaro F, Saracino A. De Vita E, et al. Front Public Health. 2025 Jul 2;13:1591767. doi: 10.3389/fpubh.2025.1591767. eCollection 2025. Front Public Health. 2025. PMID: 40672905 Free PMC article.

References

    1. Yanez ND, Weiss NS, Romand JA, Treggiari MM. COVID-19 mortality risk for older men and women. BMC Public Health. 2020;20:1742. doi: 10.1186/s12889-020-09826-8. - DOI - PMC - PubMed
    1. Gupta S, Hayek SS, Wang W, et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med. 2020;180:1436–1447. doi: 10.1001/jamainternmed.2020.3596. - DOI - PMC - PubMed
    1. Darmon M, Dumas G. Anticipating outcomes for patients with COVID-19 and identifying prognosis patterns. Lancet Infect Dis. 2021;21:744–745. doi: 10.1016/s1473-3099(21)00073-6. - DOI - PMC - PubMed
    1. Jung C, Flaatten H, Fjølner J, et al. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study. Crit Care. 2021;25:149. doi: 10.1186/s13054-021-03551-3. - DOI - PMC - PubMed
    1. Samuelsson C, Sjöberg F, Karlström G, Nolin T, Walther SM. Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age. Crit Care. 2015;19:129. doi: 10.1186/s13054-015-0873-1. - DOI - PMC - PubMed

Publication types

Associated data