Sex differences and disparities in cardiovascular outcomes of COVID-19
Por:
Bugiardini, R, Nava, S, Caramori, G, Yoon, J, Badimon, L, Bergami, M, Cenko, E, David, A, Demiri, I, Dorobantu, M, Fronea, O, Jankovic, R, Kedev, S, Ladjevic, N, Lasica, R, Loncar, G, Mancuso, G, Mendieta, G, Milicic, D, Mjehovic, P, Pasalic, M, Petrovic, M, Poposka, L, Scarpone, M, Stefanovic, M, van der Schaar, M, Vasiljevic, Z, Vavlukis, M, Pittao, MLV, Vukomanovic, V, Zdravkovic, M, Manfrini, O
Publicada:
18 ene 2023
Ahead of Print:
1 ene 2023
Resumen:
Aims Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with coronavirus disease 2019 (COVID-19) outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods and results This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes COVID-19 (NCT05188612). Participants were individuals hospitalized with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 2020 to February 2022. Risk-adjusted ratios (RRs) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women vs. men. Estimates were evaluated by inverse probability weighting and logistic regression models. The overall care cohort included 4499 patients with COVID-19-associated hospitalizations. Of these, 1524 (33.9%) were admitted to intensive care unit (ICU), and 1117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU [RR: 0.80; 95% confidence interval (CI): 0.71-0.91]. In general wards (GWs) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95% CI: 0.90-1.42) and 0.86 (95% CI: 0.70-1.05; p(interaction) = 0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (odds ratios: 2.27, 95% CI: 1.73-2.98; 3.85, 95% CI: 3.21-4.63; and 3.95, 95% CI: 3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. In contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs: 1.25; 95% CI: 0.94-1.67 vs. 0.83; 95% CI: 0.59-1.16, p(interaction) = 0.04). Conclusions Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19-related complications.
Filiaciones:
Bugiardini, R:
Univ Bologna, Dept Med & Surg Sci, Padigl 11, Via Massarenti 9, I-40138 Bologna, Italy
Nava, S:
Univ Bologna, Dept Med & Surg Sci, Padigl 11, Via Massarenti 9, I-40138 Bologna, Italy
Univ Bologna, Resp & Crit Care Unit, IRCCS Azienda Osped, Bologna, Italy
Caramori, G:
Univ Messina, Dipartimento Sci Biomed Odontoiatr & Immagini Morf, Pneumol, Messina, Italy
Yoon, J:
Google Cloud AI, Sunnyvale, CA USA
Badimon, L:
Hosp Santa Creu i Sant Pau, Ciber CV Inst Carlos 3, Cardiovasc Res Program ICCC, IR IIB Sant Pau, Barcelona, Spain
Bergami, M:
Univ Bologna, Dept Med & Surg Sci, Padigl 11, Via Massarenti 9, I-40138 Bologna, Italy
Cenko, E:
Univ Bologna, Dept Med & Surg Sci, Padigl 11, Via Massarenti 9, I-40138 Bologna, Italy
David, A:
Univ Messina, Dept Human Pathol Adult & Evolut Age Gaetano Barre, Div Anesthesia & Crit Care, Messina, Italy
Demiri, I:
Univ Ss Cyril & Methodius, Univ Clin Infect Dis, Skopje, North Macedonia
Dorobantu, M:
Carol Davila Univ Med & Pharm, Emergency Clin Hosp Bucharest, Bucharest, Romania
Fronea, O:
Carol Davila Univ Med & Pharm, Emergency Clin Hosp Bucharest, Bucharest, Romania
Jankovic, R:
Univ Nis, Univ Clin Ctr Nis, Sch Med, Clin Anesthesiol & Intens Therapy, Nish, Serbia
Kedev, S:
Univ Clin Cardiol, St Orsola Hosp, IRCCS Azienda Osped, Skopje 1000, North Macedonia
Ss Cyril & Methodius Univ Skopje, Fac Med, Skopje 1000, North Macedonia
Ladjevic, N:
Univ Belgrade, Univ Clin Ctr Serbia, Fac Med, Belgrade, Serbia
Lasica, R:
Univ Belgrade, Clin Ctr Serbia, Belgrade, Serbia
Loncar, G:
Inst Cardiovasc Dis Dedinje, Belgrade, Serbia
Mancuso, G:
Univ Messina, Dept Human Pathol, Med Microbiol, Messina, Italy
Mendieta, G:
Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid, Spain
Milicic, D:
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
Mjehovic, P:
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
Pasalic, M:
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
Petrovic, M:
Univ Novi Sad, Inst Cardiovasc Dis Vojvodina, Fac Med Novi Sad, Novi Sad, Serbia
Poposka, L:
Univ Clin Cardiol, St Orsola Hosp, IRCCS Azienda Osped, Skopje 1000, North Macedonia
Ss Cyril & Methodius Univ Skopje, Fac Med, Skopje 1000, North Macedonia
Scarpone, M:
Univ Bologna, Dept Med & Surg Sci, Padigl 11, Via Massarenti 9, I-40138 Bologna, Italy
Stefanovic, M:
Univ Ss Cyril & Methodius, Univ Clin Infect Dis, Skopje, North Macedonia
van der Schaar, M:
Univ Calif Los Angeles, Dept Elect & Comp Engn, Los Angeles, CA USA
Univ Cambridge, Cambridge Ctr Artificial Intelligence Med, Dept Appl Math & Theoret Phys, Cambridge, England
Univ Cambridge, Dept Populat Hlth, Cambridge, Cambridgeshire, United Kingdom
Vasiljevic, Z:
Univ Belgrade, Med Fac, Belgrade, Serbia
Vavlukis, M:
Univ Clin Cardiol, St Orsola Hosp, IRCCS Azienda Osped, Skopje 1000, North Macedonia
Ss Cyril & Methodius Univ Skopje, Fac Med, Skopje 1000, North Macedonia
Pittao, MLV:
Univ Bologna, Dept Med & Surg Sci, Padigl 11, Via Massarenti 9, I-40138 Bologna, Italy
Univ Bologna, Resp & Crit Care Unit, IRCCS Azienda Osped, Bologna, Italy
Vukomanovic, V:
Clin Hosp Ctr Dragisa Miskovic, Belgrade, Serbia
Zdravkovic, M:
Univ Belgrade, Clin Hosp Ctr Bezanijska kosa, Fac Med, Belgrade, Serbia
Bronze, All Open Access; Bronze
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