{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:58:09Z","timestamp":1760151489906,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical-Scientific Fund of the Mayor of Vienna","award":["CoVid004"],"award-info":[{"award-number":["CoVid004"]}]},{"name":"GENDER-NET Plus ERA-NET Cofund project GOING-FWD","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Importance: A male predominance is reported in hospitalised patients with COVID-19 alongside a higher mortality rate in men compared to women. Objective: To assess if the reported sex bias in the COVID-19 pandemic is validated by analysis of a subset of patients with severe disease. Design: A nationwide retrospective cohort study was performed using the Austrian National COVID Database. We performed a sex-specific Lasso regression to select the covariates best explaining the outcomes of mechanical ventilation and death using variables known before ICU admission. We use logistic regression to construct a sex-specific \u201crisk score\u201d for the outcomes using these variables. Setting: We studied the characteristics and outcomes of patients admitted to intensive care units (ICUs) in Austria. Participants: 5118 patients admitted to the ICU in Austria with a COVID-19 diagnosis in 03\/2020\u201303\/2021. Exposures: Demographic and clinical characteristics, vital signs and laboratory tests, comorbidities, and management of patients admitted to ICUs were analysed for possible sex differences. Main outcomes and measures: The aim was to define risk scores for mechanical ventilation and mortality for each sex to provide better sex-sensitive management and outcomes in the future. Results: We found balanced accuracies between 55% and 65% to predict the outcomes. Regarding outcome death, we found that the risk score for pre-ICU variables increases with age, renal insufficiency (f: OR 1.7(2), m: 1.9(2)) and decreases with observance as admission cause (f: OR 0.33(5), m: 0.36(5)). Additionally, the risk score for females also includes respiratory insufficiency (OR 2.4(4)) while heart failure for males only (OR 1.5(1)). Conclusions and relevance: Better knowledge of how sex influences COVID-19 outcomes at ICUs will have important implications for the ongoing pandemic\u2019s clinical care and management strategies. Identifying sex-specific features in individuals with COVID-19 and fatal consequences might inform preventive strategies and public health services.<\/jats:p>","DOI":"10.3390\/jpm12040517","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T22:08:06Z","timestamp":1648073286000},"page":"517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Sex Differences in Clinical Characteristics and Outcomes of Patients with SARS-CoV-2-Infection Admitted to Intensive Care Units in Austria"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3520-4105","authenticated-orcid":false,"given":"Alexandra","family":"Kautzky-Willer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, W\u00e4hringer G\u00fcrtel 18-20, A-1090 Vienna, Austria"},{"name":"Gender Institute, A-3571 Gars am Kamp, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9027-2266","authenticated-orcid":false,"given":"Michaela","family":"Kaleta","sequence":"additional","affiliation":[{"name":"Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"},{"name":"Complexity Science Hub Vienna, Josefst\u00e4dter Strasse 39, A-1080 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1795-6143","authenticated-orcid":false,"given":"Simon D.","family":"Lindner","sequence":"additional","affiliation":[{"name":"Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"},{"name":"Complexity Science Hub Vienna, Josefst\u00e4dter Strasse 39, A-1080 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Leutner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, W\u00e4hringer G\u00fcrtel 18-20, A-1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Thurner","sequence":"additional","affiliation":[{"name":"Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"},{"name":"Complexity Science Hub Vienna, Josefst\u00e4dter Strasse 39, A-1080 Vienna, Austria"},{"name":"Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 85701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Klimek","sequence":"additional","affiliation":[{"name":"Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"},{"name":"Complexity Science Hub Vienna, Josefst\u00e4dter Strasse 39, A-1080 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1038\/s41577-020-0348-8","article-title":"Considering how biological sex impacts immune responses and COVID-19 outcomes","volume":"20","author":"Scully","year":"2020","journal-title":"Nat. Rev. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Scully, E.P., Schumock, G., Fu, M., Massaccesi, G., Muschelli, J., Betz, J., Klein, E.Y., West, N.E., Robinson, M., and Garibaldi, B.T. (2021). Sex and gender differences in COVID testing, hospital admission, presentation, and drivers of severe outcomes in the DC\/Maryland region. medRxiv.","DOI":"10.1101\/2021.04.05.21253827"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13293-020-00304-9","article-title":"Impact of sex and gender on COVID-19 outcomes in Europe","volume":"11","author":"Gebhard","year":"2020","journal-title":"Biol. Sex Differ."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e460","DOI":"10.1016\/S2666-7568(21)00121-5","article-title":"Gender differences in countries\u2019 adaptation to societal ageing: An international cross-sectional comparison","volume":"2","author":"Chen","year":"2021","journal-title":"Lancet Healthy Longev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6141","DOI":"10.1172\/JCI142004","article-title":"Sex, age, and hospitalization drive antibody responses in a COVID-19 convalescent plasma donor population","volume":"130","author":"Klein","year":"2020","journal-title":"J. Clin. Investig."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1159\/000513346","article-title":"Sex Disparities in Covid-19 Severity and Outcome: Are Men Weaker or Women Stronger?","volume":"111","author":"Pivonello","year":"2020","journal-title":"Neuroendocrinology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"27285","DOI":"10.1073\/pnas.2012520117","article-title":"Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries","volume":"117","author":"Galasso","year":"2020","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_8","unstructured":"Global Health 50\/50, African Population and Health Research Center, and International Center for Research on Women (2021, August 30). The Sex, Gender and COVID-19 Project. Available online: https:\/\/globalhealth5050.org\/the-sex-gender-and-covid-19-project\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s13054-015-0873-1","article-title":"Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age","volume":"19","author":"Samuelsson","year":"2015","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2012270","DOI":"10.1001\/jamanetworkopen.2020.12270","article-title":"Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit","volume":"3","author":"Suleyman","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13293-021-00359-2","article-title":"Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans","volume":"12","author":"Yoshida","year":"2021","journal-title":"Biol. Sex Differ."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Nachtigall, I., Bonsignore, M., Th\u00fcrmann, P., Hohenstein, S., J\u00f3\u017awiak, K., Hauptmann, M., Eifert, S., Dengler, J., Bollmann, A., and Groesdonk, H.V. (2021). Sex Differences in Clinical Course and Intensive Care Unit Admission in a National Cohort of Hospitalized Patients with COVID-19. J. Clin. Med., 10.","DOI":"10.3390\/jcm10214954"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Iaccarino, G., Grassi, G., Borghi, C., Carugo, S., Fallo, F., Ferri, C., Giannattasio, C., Grassi, D., Letizia, C., and Mancusi, C. (2020). 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, 15.","DOI":"10.1371\/journal.pone.0237297"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13293-020-00334-3","article-title":"Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy","volume":"11","author":"Raparelli","year":"2020","journal-title":"Biol. Sex Differ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"458","DOI":"10.15585\/mmwr.mm6915e3","article-title":"Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019\u2014COVID-NET, 14 States, March 1\u201330, 2020","volume":"69","author":"Garg","year":"2020","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1111\/anae.15201","article-title":"Outcomes from intensive care in patients with COVID-19: A systematic review and meta-analysis of observational studies","volume":"75","author":"Armstrong","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6317","DOI":"10.1038\/s41467-020-19741-6","article-title":"Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission","volume":"11","author":"Peckham","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1001\/jamainternmed.2020.3539","article-title":"Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy","volume":"180","author":"Grasselli","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1111\/anae.15532","article-title":"Factors associated with mortality in patients with COVID-19 admitted to intensive care: A systematic review and meta-analysis","volume":"76","author":"Taylor","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_21","first-page":"878","article-title":"Gender and acute respiratory distress syndrome in critically injured adults: A prospective study","volume":"71","author":"Heffernan","year":"2011","journal-title":"J. Trauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1530\/EJE-21-0068","article-title":"Sex disparities in COVID-19 outcomes of inpatients with diabetes: Insights from the CORONADO study","volume":"185","author":"Tramunt","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"C13","DOI":"10.1530\/EJE-21-0721","article-title":"Commentary on Sex disparities in COVID-19 outcomes of inpatients with diabetes: Insights from the CORONADO study: Does diabetes mellitus mitigate the gender gap in COVID-19 mortality?","volume":"185","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1111\/dom.14256","article-title":"COVID-19 fatality prediction in people with diabetes and prediabetes using a simple score upon hospital admission","volume":"23","author":"Sourij","year":"2021","journal-title":"Diabetes Obes. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13613-019-0514-y","article-title":"Gender and survival of critically ill patients: Results from the FROG-ICU study","volume":"9","author":"Hollinger","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/S2213-8587(20)30160-1","article-title":"Prevalence of obesity among adult inpatients with COVID-19 in France","volume":"8","author":"Caussy","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/CCM.0000000000005216","article-title":"Body Mass Index and Mortality in Coronavirus Disease 2019 and Other Diseases: A Cohort Study in 35,506 ICU Patients","volume":"50","author":"Kooistra","year":"2021","journal-title":"Crit. Care Med."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/4\/517\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:41:23Z","timestamp":1760136083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/4\/517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,23]]},"references-count":27,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jpm12040517"],"URL":"https:\/\/doi.org\/10.3390\/jpm12040517","relation":{},"ISSN":["2075-4426"],"issn-type":[{"type":"electronic","value":"2075-4426"}],"subject":[],"published":{"date-parts":[[2022,3,23]]}}}