Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension

PLoS One. 2020 Oct 6;15(10):e0237297. doi: 10.1371/journal.pone.0237297. eCollection 2020.

Abstract

Background: The global rate of intensive care unit (ICU) admission during the COVID-19 pandemic varies within countries and is among the main challenges for health care systems worldwide. Conflicting results have been reported about the response to coronavirus infection and COVID-19 outcomes in men and women. Understanding predictors of intensive care unit admission might be of help for future planning and management of the disease.

Methods and findings: We designed a cross-sectional observational multicenter nationwide survey in Italy to understand gender-related clinical predictors of ICU admission in patients with COVID-19. We analyzed information from 2378 charts of Italian patients certified for COVID-19 admitted in 26 hospitals. Three hundred ninety-five patients (16.6%) required ICU admission due to COVID19 infection, more frequently men (74%), with a higher prevalence of comorbidities (1,78±0,06 vs 1,54±0,03 p<0.05). In multivariable regression model main predictors of admission to ICU are male gender (OR 1,74 95% CI 1,36-2,22 p<0.0001) and presence of obesity (OR 2,88 95% CI 2,03-4,07 p<0.0001), chronic kidney disease (OR: 1,588; 95%, 1,036-2,434 p<0,05) and hypertension (OR: 1,314; 95% 1,039-1,662; p<0,05). In gender specific analysis, obesity, chronic kidney disease and hypertension are associated with higher rate of admission to ICU among men, whereas in women, obesity (OR: 2,564; 95% CI 1,336-4.920 p<0.0001) and heart failure (OR: 1,775 95% CI: 1,030-3,057) are associated with higher rate of ICU admission.

Conclusions: Our study demonstrates that gender is the primary determinant of the disease's severity among COVID-19. Obesity is the condition more often observed among those admitted to ICU within both genders.

Trial registration: Clinicaltrials.gov: NCT04331574.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus / genetics*
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / virology
  • Cross-Sectional Studies
  • Female
  • Heart Failure
  • Humans
  • Hypertension
  • Intensive Care Units*
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Obesity
  • Pandemics
  • Patient Admission*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / virology
  • Renal Insufficiency, Chronic
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index*
  • Sex Factors
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT04331574

Grants and funding

This work was supported by the Italian Society of Hypertension, who provided secretariat, logistic, communication, publication cost coverage. The funders had no additional role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.