Long-term outcome after intensive care for COVID-19: differences between men and women-a nationwide cohort study

Crit Care. 2021 Feb 25;25(1):86. doi: 10.1186/s13054-021-03511-x.


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.

Keywords: COVID-19; Gender; Intensive care; Long-term outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • COVID-19 / mortality
  • COVID-19 / therapy*
  • Cohort Studies
  • Critical Care*
  • Female
  • Health Status Disparities*
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Sex Factors
  • Sweden / epidemiology
  • Time Factors
  • Treatment Outcome