Sex Differences in Clinical Characteristics and Outcomes of Patients with SARS-CoV-2-Infection Admitted to Intensive Care Units in Austria.

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 "risk score" 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 03/2020-03/2021. 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's 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.

Meteorological factors and non-pharmaceutical interventions explain local differences in the spread of SARS-CoV-2 in Austria.

The drivers behind regional differences of SARS-CoV-2 spread on finer spatio-temporal scales are yet to be fully understood. Here we develop a data-driven modelling approach based on an age-structured compartmental model that compares 116 Austrian regions to a suitably chosen control set of regions to explain variations in local transmission rates through a combination of meteorological factors, non-pharmaceutical interventions and mobility. We find that more than 60% of the observed regional variations can be explained by these factors. Decreasing temperature and humidity, increasing cloudiness, precipitation and the absence of mitigation measures for public events are the strongest drivers for increased virus transmission, leading in combination to a doubling of the transmission rates compared to regions with more favourable weather. We conjecture that regions with little mitigation measures for large events that experience shifts toward unfavourable weather conditions are particularly predisposed as nucleation points for the next seasonal SARS-CoV-2 waves.

Agent-based simulations for protecting nursing homes with prevention and vaccination strategies.

Due to its high lethality among older people, the safety of nursing homes has been of central importance during the COVID-19 pandemic. With test procedures and vaccines becoming available at scale, nursing homes might relax prohibitory measures while controlling the spread of infections. By control we mean that each index case infects less than one other person on average. Here, we develop an agent-based epidemiological model for the spread of SARS-CoV-2 calibrated to Austrian nursing homes to identify optimal prevention strategies. We find that the effectiveness of mitigation testing depends critically on test turnover time (time until test result), the detection threshold of tests and mitigation testing frequencies. Under realistic conditions and in absence of vaccinations, we find that mitigation testing of employees only might be sufficient to control outbreaks if tests have low turnover times and detection thresholds. If vaccines that are 60% effective against high viral load and transmission are available, control is achieved if 80% or more of the residents are vaccinated, even without mitigation testing and if residents are allowed to have visitors. Since these results strongly depend on vaccine efficacy against infection, retention of testing infrastructures, regular testing and sequencing of virus genomes is advised to enable early identification of new variants of concern.

Sex Differences in Clinical Characteristics and Outcomes of Patients with SARS-CoV-2-Infection Admitted to Intensive Care Units in Austria

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 'risk score';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 03/2020–03/2021. 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's 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.

Severe Acute Respiratory Distress Syndrome (ARDS) or Severely Increased Chest Wall Elastance?

Esophageal manometry can be used to calculate transpulmonary pressures and optimize ventilator settings accordingly. We present the case of a 31-year-old male patient with ataxia-telangiectasia (Louis-Bar syndrome) and a BMI of 20 kg/m2, admitted to our intensive care unit for coronavirus disease 2019 (COVID-19) pneumonia. The patient soon required mechanical ventilation; however, there was very poor respiratory system compliance. Cholecystitis complicated the clinical course, and veno-venous extracorporeal membrane oxygenation (ECMO) was initiated as gas exchange deteriorated. Esophageal manometry was introduced and revealed severely increased intrathoracic pressure and chest wall elastance.