Sex Differences In The Mortality Of Hospitalized Patients With COVID-19 And Non-ICU Policies In The Netherlands

Introduction: Several international studies have reported sex differences in COVID-19 mortality. The Dutch healthcare system is characterized by as strong focus on primary care and active patient participation in medical choices, such as invasive therapies. This study aims at identifying potential sex-specific predictors of in-hospital mortality and non-ICU policy in patients with COVID-19. Methods: In this observational cohort study, we included participants hospitalized with COVID-19 during the first wave (March-May 2020) of the pandemic in six regional hospitals in the Netherlands. We computed descriptive statistics and logistic regression models using sex-disaggregated data to identify predictors of in-hospital mortality. Followingly, we analyzed the clinical features of female and male COVID-19 patients who had a non-ICU policy.Results: We included 1262 patients (63.7% men) in this study. Higher age, higher LDH level, lower diastolic blood pressure, and lower peripheral oxygen saturation were associated with in-hospital mortality in female and male patients. Shorter symptom duration before admission and more comorbidities associated with in-hospital mortality only in female patients. 33.8% of the female and 30.6% of the male patients had a non-ICU policy. We identified a significant rise in this policy in female patients over the course of the first wave compared to males, which could not be explained solely by age and clinical differences. Discussion: Potential sex differences in symptom development and the sex-specific impact of immune dysfunction on COVID-19 prognosis need further evaluation. Sex differences in ICU care preferences of these patients should be examined to identify underlying gender-related patterns.