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

• DOI: 10.1371/journal.pone.0237297
• Publication Date: 2020-10-06T17:22:23Z
• Authors: Guido Iaccarino; Guido Grassi; Claudio Borghi; Stefano Carugo; Francesco Fallo; Claudio Ferri; Cristina Giannatt...; Davide Grassi; Claudio Letizia; Costantino Mancusi; Pietro Minuz; Stefano Perlini; Giacomo Pucci; Damiano Rizzoni; Massimo Salvetti; Riccardo Sarzani; Leonardo Sechi; Franco Veglio; Massimo Volpe; Maria Lorenza Mui...
• Keywords: COVID-19, gender, obesity; Adult; Male; Adolescent; Science; Adolescent; Adult; Aged; Aged, 80 and over; Betacoronavirus; COVID-19; Coronavirus Infections; Cross-Sectional Studies; Female; Heart Failure; Humans; Hypertension; Italy; Male; Middle Aged; Obesity; Pandemics; Pneumonia, Viral; Renal Insufficiency, Chronic; Risk Factors; SARS-CoV-2; Sex Factors; Young Adult; Intensive Care Units; Patient Admission; Severity of Illness Index; Pneumonia, Viral; Hyperyension; Covid;; Severity of Illness Index; Adolescent; Adult; Aged; Aged, 80 and over; Betacoronavirus; Coronavirus Infections; Cross-Sectional Studies; Female; Heart Failure; Humans; Hypertension; Italy; Male; Middle Aged; Obesity; Pandemics; Pneumonia, Viral; Renal Insufficiency, Chronic; Risk Factors; Sex Factors; Young Adult; Intensive Care Units; Patient Admission; Severity of Illness Index; Young Adult; Betacoronavirus; 03 medical and health sciences; Sex Factors; Patient Admission; 0302 clinical medicine; 5. Gender equality; Risk Factors; 80 and over; Humans; Viral; Renal Insufficiency; Obesity; Chronic; 10. No inequality; Pandemics; Aged; Aged, 80 and over; Heart Failure; 2. Zero hunger; Q; R; COVID-19; SARS_CoV-2, Gender, intensive care, prediction; Pneumonia; Middle Aged; Hypertension, COVID19; 3. Good health; Intensive Care Units; Cross-Sectional Studies; Italy; Hypertension; Medicine; Female; Coronavirus Infections; Research Article

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.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.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.Clinicaltrials.gov: NCT04331574.