{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:12:10Z","timestamp":1792098730870,"version":"4.4.0"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100020853","name":"Dipartimento di Medicina e Chirurgia, Universit\u00e0 degli Studi di Milano-Bicocca","doi-asserted-by":"publisher","award":["Bicocca Starting grant 2020 from the University of Milano-Bicocca with the project titled: \u201cFunctional Residual Capacity Assessment using a Wash-In\/Wash-Out technique based on a fast main-stream O2 Sensor with nanofluorescenT geometry for severe lung injury (FAST)\u2014 COVID"],"award-info":[{"award-number":["Bicocca Starting grant 2020 from the University of Milano-Bicocca with the project titled: \u201cFunctional Residual Capacity Assessment using a Wash-In\/Wash-Out technique based on a fast main-stream O2 Sensor with nanofluorescenT geometry for severe lung injury (FAST)\u2014 COVID"]}],"id":[{"id":"10.13039\/501100020853","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020853","name":"Dipartimento di Medicina e Chirurgia, Universit\u00e0 degli Studi di Milano-Bicocca","doi-asserted-by":"publisher","award":["beyond\u201d"],"award-info":[{"award-number":["beyond\u201d"]}],"id":[{"id":"10.13039\/501100020853","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["ICMx"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sex-related differences have been consistently reported in the epidemiology of acute hypoxemic respiratory failure (AHRF) and COVID-19. However, whether computed tomography (CT)-derived measures of lung injury differ between sexes and contribute to outcome disparities remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this large multicenter retrospective cohort study, we analyzed 850 spontaneously breathing patients with COVID-19-related AHRF who underwent early chest CT at hospital admission. Quantitative CT analysis provided measures of lung density, volume, mass, and superimposed pressure (SP), a CT-derived estimate of gravitational stress. Sex-stratified analyses compared morphological, physiological, and outcome variables. Multivariable logistic regression models identified independent predictors of mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 850 patients (35% women), men exhibited larger lung volume (2.91 vs. 2.28 L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), greater lung mass (1.14 vs. 0.93\u00a0kg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and higher SP (5.79 vs. 5.21 cmH\u2082O,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) despite similar fractions of ground-glass opacities and consolidation. In the multivariable model, older age (OR 1.08, 95% CI 1.06\u20131.11;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), lower PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      (OR 0.99, 95% CI 0.98\u20130.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), higher SOFA score (OR 2.67, 95% CI 1.43\u20134.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002 for SOFA\u2009\u2265\u20092), higher global SP (OR 1.18, 95% CI 1.05\u20131.34;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), and male sex (OR 1.76, 95% CI 1.06\u20132.92;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028) were independently associated with an increased risk of mortality. In the mediation analysis, the effect of global SP on mortality does not appear to be mediated by male sex (coefficient 0.00).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Male patients with COVID-19-related AHRF exhibited higher global SP than females, reflecting greater gravitational lung load and mechanical disadvantage. Both global SP and male sex were independently associated with mortality, with no evidence of mediation of male sex on mortality. These finding suggest that, beyond anatomical and mechanical differences, biological and hormonal factors likely contribute to the increased disease severity observed in men.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40635-026-00914-4","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:04:45Z","timestamp":1781600685000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex-related differences in lung injury distribution and outcomes in COVID-19 acute respiratory failure: insights from the CT-COVID19 multicenter study group"],"prefix":"10.1186","volume":"14","author":[{"given":"Davide","family":"Signori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Nova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Gerard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Magliocca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Mussoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Montomoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Subert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Ponti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savino","family":"Spadaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarla","family":"Poli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Casola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Garberi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Restivo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Raimondi Cominesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Giani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Zambelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Foti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Laffey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Cereda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4506-7212","authenticated-orcid":false,"given":"Emanuele","family":"Rezoagli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the CT-COVID19 Multicenter Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Bonaffini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cazzaniga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinando Luca","family":"Lorini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Ottaviani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asia","family":"Borgo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Tavola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livio","family":"Ferraris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Bellani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Gatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Ippolito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Restivo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Serra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Arlotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marino","family":"Gatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Tamagnini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Cavagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiliano","family":"Gamberini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide De","family":"Ponti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Galbiati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Giacomini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"issue":"9","key":"914_CR1","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1164\/ajrccm.164.9.2103121","volume":"164","author":"L Gattinoni","year":"2001","unstructured":"Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164(9):1701\u20131711. https:\/\/doi.org\/10.1164\/ajrccm.164.9.2103121","journal-title":"Am J Respir Crit Care Med"},{"issue":"Suppl","key":"914_CR2","doi-asserted-by":"publisher","first-page":"S285","DOI":"10.1097\/01.CCM.0000057905.74813.BC","volume":"31","author":"JJ Rouby","year":"2003","unstructured":"Rouby JJ, Puybasset L, Nieszkowska A, Lu Q (2003) Acute respiratory distress syndrome: lessons from computed tomography of the whole lung: Crit Care Med 31(Suppl):S285\u2013S295. https:\/\/doi.org\/10.1097\/01.CCM.0000057905.74813.BC","journal-title":"Crit Care Med"},{"issue":"6","key":"914_CR3","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1007\/s00134-005-2627-z","volume":"31","author":"L Gattinoni","year":"2005","unstructured":"Gattinoni L, Pesenti A (2005) The concept of \u201cbaby lung.\u201d Intensive Care Med 31(6):776\u2013784. https:\/\/doi.org\/10.1007\/s00134-005-2627-z","journal-title":"Intensive Care Med"},{"issue":"1","key":"914_CR4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/00000542-199101000-00004","volume":"74","author":"L Gattinoni","year":"1991","unstructured":"Gattinoni L, Pelosi P, Vitale G, Pesenti A, D\u2019Andrea L, Mascheroni D (1991) Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 74(1):15\u201323. https:\/\/doi.org\/10.1097\/00000542-199101000-00004","journal-title":"Anesthesiology"},{"issue":"3","key":"914_CR5","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00435-2019","volume":"54","author":"D Chiumello","year":"2019","unstructured":"Chiumello D, Sferrazza Papa GF, Artigas A, Bouhemad B, Grgic A, Heunks L et al (2019) ERS statement on chest imaging in acute respiratory failure. Eur Respir J 54(3):1900435. https:\/\/doi.org\/10.1183\/13993003.00435-2019","journal-title":"Eur Respir J"},{"issue":"3","key":"914_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/cc12738","volume":"17","author":"M Cressoni","year":"2013","unstructured":"Cressoni M, Gallazzi E, Chiurazzi C, Marino A, Brioni M, Menga F et al (2013) Limits of normality of quantitative thoracic CT analysis. Crit Care 17(3):R93. https:\/\/doi.org\/10.1186\/cc12738","journal-title":"Crit Care"},{"issue":"3","key":"914_CR7","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1097\/00005382-198607000-00005","volume":"1","author":"L Gattinoni","year":"1986","unstructured":"Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F et al (1986) Adult respiratory distress syndrome profiles by computed tomography: J Thorac Imaging 1(3):25\u201330. https:\/\/doi.org\/10.1097\/00005382-198607000-00005","journal-title":"J Thorac Imaging"},{"issue":"3","key":"914_CR8","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/00005382-198807000-00013","volume":"3","author":"L Gattinoni","year":"1988","unstructured":"Gattinoni L, Pesenti A, Baglioni S, Vitale G, Rivolta M, Pelosi P (1988) Inflammatory pulmonary edema and positive end-expiratory pressure: correlations between imaging and physiologic studies. J Thorac Imaging 3(3):59\u201364. https:\/\/doi.org\/10.1097\/00005382-198807000-00013","journal-title":"J Thorac Imaging"},{"issue":"16","key":"914_CR9","doi-asserted-by":"publisher","first-page":"2122","DOI":"10.1001\/jama.1993.03500160092039","volume":"269","author":"L Gattinoni","year":"1993","unstructured":"Gattinoni L, D\u2019Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269(16):2122\u20132127. https:\/\/doi.org\/10.1001\/jama.1993.03500160092039","journal-title":"JAMA"},{"issue":"2","key":"914_CR10","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1148\/radiology.213.2.r99nv42545","volume":"213","author":"LR Goodman","year":"1999","unstructured":"Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L et al (1999) Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 213(2):545\u2013552. https:\/\/doi.org\/10.1148\/radiology.213.2.r99nv42545","journal-title":"Radiology"},{"issue":"5","key":"914_CR11","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1016\/j.chest.2016.03.016","volume":"150","author":"S Mrozek","year":"2016","unstructured":"Mrozek S, Jabaudon M, Jaber S, Paugam-Burtz C, Lefrant JY, Rouby JJ et al (2016) Elevated plasma levels of sRAGE are associated with nonfocal CT-based lung imaging in patients with ARDS. Chest 150(5):998\u20131007. https:\/\/doi.org\/10.1016\/j.chest.2016.03.016","journal-title":"Chest"},{"issue":"8","key":"914_CR12","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1007\/s001340051317","volume":"26","author":"JJ Rouby","year":"2000","unstructured":"Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q, Grenier P (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS severity score. Intensive Care Med 26(8):1046\u20131056. https:\/\/doi.org\/10.1007\/s001340051317","journal-title":"Intensive Care Med"},{"issue":"10","key":"914_CR13","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1016\/S2213-2600(19)30138-9","volume":"7","author":"JM Constantin","year":"2019","unstructured":"Constantin JM, Jabaudon M, Lefrant JY, Jaber S, Quenot JP, Langeron O et al (2019) Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med 7(10):870\u2013880. https:\/\/doi.org\/10.1016\/S2213-2600(19)30138-9","journal-title":"Lancet Respir Med"},{"issue":"14","key":"914_CR14","doi-asserted-by":"publisher","first-page":"282","DOI":"10.21037\/atm.2017.06.62","volume":"5","author":"E Rezoagli","year":"2017","unstructured":"Rezoagli E, Fumagalli R, Bellani G (2017) Definition and epidemiology of acute respiratory distress syndrome. Ann Transl Med 5(14):282\u2013282. https:\/\/doi.org\/10.21037\/atm.2017.06.62","journal-title":"Ann Transl Med"},{"issue":"1","key":"914_CR15","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1186\/s13054-024-05046-3","volume":"28","author":"E Rezoagli","year":"2024","unstructured":"Rezoagli E, Xin Y, Signori D, Sun W, Gerard S, Delucchi KL et al (2024) Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan. Crit Care 28(1):263. https:\/\/doi.org\/10.1186\/s13054-024-05046-3","journal-title":"Crit Care"},{"issue":"1","key":"914_CR16","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s40635-026-00880-x","volume":"14","author":"R Garberi","year":"2026","unstructured":"Garberi R, Jabaudon M, Bayat S, Gerard SE, Magliocca A, Pellegrini M et al (2026) Characterizing heterogeneity and subphenotyping acute respiratory distress syndrome with computed tomography. Intensive Care Med Exp 14(1):38. https:\/\/doi.org\/10.1186\/s40635-026-00880-x","journal-title":"Intensive Care Med Exp"},{"issue":"1","key":"914_CR17","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/s13054-022-04251-2","volume":"26","author":"DFL Filippini","year":"2022","unstructured":"Filippini DFL, Di Gennaro E, Van Amstel RBE, Beenen LFM, Grasso S, Pisani L et al (2022) Latent class analysis of imaging and clinical respiratory parameters from patients with COVID-19-related ARDS identifies recruitment subphenotypes. Crit Care 26(1):363. https:\/\/doi.org\/10.1186\/s13054-022-04251-2","journal-title":"Crit Care"},{"issue":"1","key":"914_CR18","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1186\/s13054-024-05143-3","volume":"28","author":"M Nishikimi","year":"2024","unstructured":"Nishikimi M, Ohshimo S, Bellani G, Fukumoto W, Anzai T, Liu K et al (2024) Identification of novel sub-phenotypes of severe ARDS requiring ECMO using latent class analysis. Crit Care 28(1):343. https:\/\/doi.org\/10.1186\/s13054-024-05143-3","journal-title":"Crit Care"},{"issue":"1","key":"914_CR19","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1186\/s13054-024-05046-3PubMedPMID:39103945;PubMedCentralPMCID:PMC11301830","volume":"28","author":"E Rezoagli","year":"2024","unstructured":"Rezoagli E, Xin Y, Signori D, Sun W, Gerard S, Delucchi KL et al (2024) Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan. Crit Care Lond Engl 28(1):263. https:\/\/doi.org\/10.1186\/s13054-024-05046-3PubMedPMID:39103945;PubMedCentralPMCID:PMC11301830","journal-title":"Crit Care Lond Engl"},{"issue":"4","key":"914_CR20","doi-asserted-by":"publisher","first-page":"1900609","DOI":"10.1183\/13993003.00609-2019","volume":"54","author":"BA McNicholas","year":"2019","unstructured":"McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S et al (2019) Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J 54(4):1900609. https:\/\/doi.org\/10.1183\/13993003.00609-2019","journal-title":"Eur Respir J"},{"issue":"8","key":"914_CR21","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1001\/jama.2016.0291","volume":"315","author":"G Bellani","year":"2016","unstructured":"Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A et al (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315(8):788. https:\/\/doi.org\/10.1001\/jama.2016.0291","journal-title":"JAMA"},{"issue":"8","key":"914_CR22","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1007\/s10654-022-00866-5","volume":"37","author":"P Geldsetzer","year":"2022","unstructured":"Geldsetzer P, Mukama T, Jawad NK, Riffe T, Rogers A, Sudharsanan N (2022) Sex differences in the mortality rate for coronavirus disease 2019 compared to other causes of death: an analysis of population-wide data from 63 countries. Eur J Epidemiol 37(8):797\u2013806. https:\/\/doi.org\/10.1007\/s10654-022-00866-5","journal-title":"Eur J Epidemiol"},{"issue":"7","key":"914_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0254066","volume":"16","author":"NT Nguyen","year":"2021","unstructured":"Nguyen NT, Chinn J, De Ferrante M, Kirby KA, Hohmann SF, Amin A (2021) Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS ONE 16(7):e0254066. https:\/\/doi.org\/10.1371\/journal.pone.0254066","journal-title":"PLoS ONE"},{"issue":"1","key":"914_CR24","doi-asserted-by":"publisher","DOI":"10.1186\/s13293-022-00481-9","volume":"13","author":"S Almuntashiri","year":"2022","unstructured":"Almuntashiri S, Jones TW, Wang X, Sikora A, Zhang D (2022) Plasma TIMP-1 as a sex-specific biomarker for acute lung injury. Biol Sex Differ 13(1):70. https:\/\/doi.org\/10.1186\/s13293-022-00481-9","journal-title":"Biol Sex Differ"},{"issue":"1","key":"914_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/s13293-022-00417-3","volume":"13","author":"CG Arnold","year":"2022","unstructured":"Arnold CG, Libby A, Vest A, Hopkinson A, Monte AA (2022) Immune mechanisms associated with sex-based differences in severe COVID-19 clinical outcomes. Biol Sex Differ 13(1):7. https:\/\/doi.org\/10.1186\/s13293-022-00417-3","journal-title":"Biol Sex Differ"},{"issue":"7","key":"914_CR26","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1038\/s41577-020-0348-8","volume":"20","author":"EP Scully","year":"2020","unstructured":"Scully EP, Haverfield J, Ursin RL, Tannenbaum C, Klein SL (2020) Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol 20(7):442\u2013447. https:\/\/doi.org\/10.1038\/s41577-020-0348-8","journal-title":"Nat Rev Immunol"},{"issue":"1","key":"914_CR27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed-2022-000245","volume":"2","author":"C Hockham","year":"2023","unstructured":"Hockham C, Linschoten M, Asselbergs FW, Ghossein C, Woodward M, Peters SAE (2023) Sex differences in cardiovascular complications and mortality in hospital patients with COVID-19: registry based observational study. BMJ Med 2(1):e000245. https:\/\/doi.org\/10.1136\/bmjmed-2022-000245","journal-title":"BMJ Med"},{"key":"914_CR28","unstructured":"Transfer learning for segmentation of injured lungs using coarse-to-fine convolutional neural networks\u2014University of Iowa. https:\/\/iro.uiowa.edu\/esploro\/outputs\/confe renceProceeding\/Transfer-Learning-for-Segmentation-of-Injured\/99840 06440502771."},{"key":"914_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2019.101592","volume":"60","author":"SE Gerard","year":"2020","unstructured":"Gerard SE, Herrmann J, Kaczka DW, Musch G, Fernandez-Bustamante A, Reinhardt JM (2020) Multi-resolution convolutional neural networks for fully automated segmentation of acutely injured lungs in multiple species. Med Image Anal 60:101592. https:\/\/doi.org\/10.1016\/j.media.2019.101592","journal-title":"Med Image Anal"},{"issue":"1","key":"914_CR30","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-80936-4","volume":"11","author":"SE Gerard","year":"2021","unstructured":"Gerard SE, Herrmann J, Xin Y, Martin KT, Rezoagli E, Ippolito D et al (2021) CT image segmentation for inflamed and fibrotic lungs using a multi-resolution convolutional neural network. Sci Rep 11(1):1455. https:\/\/doi.org\/10.1038\/s41598-020-80936-4","journal-title":"Sci Rep"},{"issue":"3","key":"914_CR31","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1016\/j.neuroimage.2006.01.015","volume":"31","author":"PA Yushkevich","year":"2006","unstructured":"Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC et al (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31(3):1116\u20131128. https:\/\/doi.org\/10.1016\/j.neuroimage.2006.01.015","journal-title":"Neuroimage"},{"key":"914_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejro.2020.100272","volume":"7","author":"V Mergen","year":"2020","unstructured":"Mergen V, Kobe A, Bl\u00fcthgen C, Euler A, Flohr T, Frauenfelder T et al (2020) Deep learning for automatic quantification of lung abnormalities in COVID-19 patients: first experience and correlation with clinical parameters. Eur J Radiol Open 7:100272. https:\/\/doi.org\/10.1016\/j.ejro.2020.100272","journal-title":"Eur J Radiol Open"},{"key":"914_CR33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2021.109583","volume":"139","author":"K Gong","year":"2021","unstructured":"Gong K, Wu D, Arru CD, Homayounieh F, Neumark N, Guan J et al (2021) A multi-center study of COVID-19 patient prognosis using deep learning-based CT image analysis and electronic health records. Eur J Radiol 139:109583. https:\/\/doi.org\/10.1016\/j.ejrad.2021.109583","journal-title":"Eur J Radiol"},{"issue":"4","key":"914_CR34","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.2020200048","volume":"2","author":"S Chaganti","year":"2020","unstructured":"Chaganti S, Grenier P, Balachandran A, Chabin G, Cohen S, Flohr T et al (2020) Automated quantification of CT patterns associated with COVID-19 from chest CT. Radiol Artif Intell 2(4):e200048. https:\/\/doi.org\/10.1148\/ryai.2020200048","journal-title":"Radiol Artif Intell"},{"key":"914_CR35","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00377.2025","author":"A Nova","year":"2025","unstructured":"Nova A, Xin Y, Victor M, Gaulton TG, Alcala GC, Winkler T et al (2025) Biomechanical implications of mass loading in a swine model of acute hypoxemic respiratory failure. J Appl Physiol. https:\/\/doi.org\/10.1152\/japplphysiol.00377.2025","journal-title":"J Appl Physiol"},{"issue":"1","key":"914_CR36","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-05097-6","volume":"28","author":"S Spina","year":"2024","unstructured":"Spina S, Mantz L, Xin Y, Moscho DC, Ribeiro De Santis Santiago R, Grassi L et al (2024) The pleural gradient does not reflect the superimposed pressure in patients with class III obesity. Crit Care 28(1):306. https:\/\/doi.org\/10.1186\/s13054-024-05097-6","journal-title":"Crit Care"},{"issue":"1","key":"914_CR37","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1164\/ajrccm.149.1.8111603","volume":"149","author":"P Pelosi","year":"1994","unstructured":"Pelosi P, D\u2019Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149(1):8\u201313. https:\/\/doi.org\/10.1164\/ajrccm.149.1.8111603","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"914_CR38","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1097\/ALN.0000000000000373","volume":"121","author":"M Cressoni","year":"2014","unstructured":"Cressoni M, Chiumello D, Carlesso E, Chiurazzi C, Amini M, Brioni M et al (2014) Compressive forces and computed tomography-derived positive end-expiratory pressure in acute respiratory distress syndrome. Anesthesiology 121(3):572\u2013581. https:\/\/doi.org\/10.1097\/ALN.0000000000000373","journal-title":"Anesthesiology"},{"issue":"10","key":"914_CR39","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/S2213-2600(25)00126-2","volume":"13","author":"A Sarma","year":"2025","unstructured":"Sarma A, Sullivan KM, Baugh AD, Bhakta NR, Calfee CS (2025) Evaluating the generalisability of formulas used to set tidal volumes in mechanically ventilated patients: an observational, multicohort, retrospective study. Lancet Respir Med 13(10):877\u2013886. https:\/\/doi.org\/10.1016\/S2213-2600(25)00126-2","journal-title":"Lancet Respir Med"},{"key":"914_CR40","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202502-0505RL","author":"AC Monteiro","year":"2025","unstructured":"Monteiro AC, Bartek B, Tripathi S, Calfee CS, Matthay MA, Sinha P (2025) Short stature is an independent risk factor for ventilatory inefficiency and higher mortality in ARDS. Am J Respir Crit Care Med. https:\/\/doi.org\/10.1164\/rccm.202502-0505RL","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"914_CR41","doi-asserted-by":"publisher","first-page":"1900609","DOI":"10.1183\/13993003.00609-2019","volume":"54","author":"BA McNicholas","year":"2019","unstructured":"McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S et al (2019) Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J 54(4):1900609. https:\/\/doi.org\/10.1183\/13993003.00609-2019","journal-title":"Eur Respir J"},{"key":"914_CR42","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.ymeth.2022.07.007","volume":"205","author":"M Connell","year":"2022","unstructured":"Connell M, Xin Y, Gerard SE, Herrmann J, Shah PK, Martin KT et al (2022) Unsupervised segmentation and quantification of COVID-19 lesions on computed tomography scans using CycleGAN. Methods 205:200\u2013209. https:\/\/doi.org\/10.1016\/j.ymeth.2022.07.007","journal-title":"Methods"},{"issue":"1","key":"914_CR43","doi-asserted-by":"publisher","DOI":"10.1016\/j.chstcc.2025.100231","volume":"4","author":"E Rezoagli","year":"2026","unstructured":"Rezoagli E, Signori D, Xin Y, Gerard S, Magliocca A, Graziano F et al (2026) Superimposed pressure for predicting mortality in acute respiratory failure during spontaneous breathing. CHEST Crit Care 4(1):100231. https:\/\/doi.org\/10.1016\/j.chstcc.2025.100231","journal-title":"CHEST Crit Care"},{"issue":"2","key":"914_CR44","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.anclin.2021.02.003","volume":"39","author":"E Rezoagli","year":"2021","unstructured":"Rezoagli E, Magliocca A, Bellani G, Pesenti A, Grasselli G (2021) Development of a critical care response\u2014experiences from Italy during the coronavirus disease 2019 pandemic. Anesthesiol Clin 39(2):265\u2013284. https:\/\/doi.org\/10.1016\/j.anclin.2021.02.003","journal-title":"Anesthesiol Clin"},{"issue":"12","key":"914_CR45","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1007\/s00134-020-06141-z","volume":"46","author":"S Horie","year":"2020","unstructured":"Horie S, McNicholas B, Rezoagli E, Pham T, Curley G, McAuley D et al (2020) Emerging pharmacological therapies for ARDS: COVID-19 and beyond. Intensive Care Med 46(12):2265\u20132283. https:\/\/doi.org\/10.1007\/s00134-020-06141-z","journal-title":"Intensive Care Med"},{"issue":"1","key":"914_CR46","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04065-2","volume":"26","author":"PD Wendel-Garcia","year":"2022","unstructured":"Wendel-Garcia PD, Moser A, Jeitziner MM, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J et al (2022) Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry. Crit Care 26(1):199. https:\/\/doi.org\/10.1186\/s13054-022-04065-2","journal-title":"Crit Care"}],"container-title":["Intensive Care Medicine Experimental"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00914-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40635-026-00914-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00914-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:04:53Z","timestamp":1781600693000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40635-026-00914-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["914"],"URL":"https:\/\/doi.org\/10.1186\/s40635-026-00914-4","relation":{},"ISSN":["2197-425X"],"issn-type":[{"value":"2197-425X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]},"assertion":[{"value":"6 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"76"}}