How did women's distribution of intensive care mortality change before and during the Sars CoV2 pandemic?

Men have a higher hospital mortality rate than women. Although the female advantage in mortality persisted during the pandemic period, little is known about the decline of this advantage. In our study, we examined how the gender distribution of patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) and their mortality changed in the years preceding and during the pandemic of Sars CoV2. Patients and methods The study has designed as a retrospective, observational, cross-sectional investigation in a teaching hospital's ICU of the third level. All ICU patients admitted between 2017 and 2022 were included in the study. 2017 and 2019 have been defined as the pre-pandemic period, while 2020 and 2022 were identified as the pandemic period. The characteristics, comorbidities, causes of ARF, presence of Covid-19 in the pandemic, ICU data, duration of ICU stay, and mortality of the patients were recorded. Patients are divided by sex. Data and mortality rates were compared across sexes and pre- and pandemic periods. Results Before the pandemic, n = 3867 (females, n = 1257, 32.5%), and during, n = 6099 (females, n = 2163, 35.5%) (p = 0.002). Female patients were 30.9%, 34.1%, 32.4%, 34.7%, 34.5%, and 36.7% from 2017 to 2022 (p = 0.010). Female were older than men (median age 73 vs. 69 and 72 vs. 67, p < 0.001). Female used IMV more than before the epidemic (p = 0.006). Female with APACHE II scores of 25 or higher increased considerably (35% vs. 32%, p = 0.049) after the epidemic. Both groups' ICU admissions pre- and post-pandemic were similar. During the pandemic, Covid-19 frequency was similar in both sexes (22% vs 23.9%, p = 0.085), but female mortality due to Covid-19 was higher (37.7% vs 32.7%, p = 0.064), while male mortality rates in those without Covid-19 were significantly higher (26.5% vs 22.5%, p = 0.002). Female mortality rates of 30.6% and male mortality rates of 69.4% (p = 0.19) were similar to those of survivors among 839 patients (21.7%) who died before the pandemic. The 1661 (27.2%) pandemic deaths were 33.6%women and 66.4% were men (p = 0.062). Conclusion Before and during the pandemic, female patients were followed up in the ICU at a rate of one-third that of male patients. Mortality in women hospitalized in the intensive care unit with acute respiratory failure was higher than in men during the pandemic period, with advanced age and Covid-19; however, the sex distribution was comparable during both periods, despite the rise in overall mortality rates during the pandemic.