Dataset
Sex-related differences in lung injury distribution and outcomes in COVID-19 acute respiratory failure: insights from the CT-COVID19 multicenter study group
figshare
06/16/2026
DOI: 10.6084/m9.figshare.c.8540866
Abstract
Abstract Background 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. Methods 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. Results Among 850 patients (35% women), men exhibited larger lung volume (2.91 vs. 2.28 L, p < 0.001), greater lung mass (1.14 vs. 0.93 kg, p < 0.001), and higher SP (5.79 vs. 5.21 cmH₂O, p < 0.001) despite similar fractions of ground-glass opacities and consolidation. In the multivariable model, older age (OR 1.08, 95% CI 1.06–1.11; p < 0.001), lower PaO2/FiO2 (OR 0.99, 95% CI 0.98–0.99; p < 0.001), higher SOFA score (OR 2.67, 95% CI 1.43–4.98; p = 0.002 for SOFA ≥ 2), higher global SP (OR 1.18, 95% CI 1.05–1.34; p = 0.005), and male sex (OR 1.76, 95% CI 1.06–2.92; p = 0.028) 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). Conclusions 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.
Details
- Title: Subtitle
- Sex-related differences in lung injury distribution and outcomes in COVID-19 acute respiratory failure: insights from the CT-COVID19 multicenter study group
- Creators
- Davide SignoriAlice Nova - Azienda Ospedaliera San GerardoYi Xin - Massachusetts General HospitalSarah E. Gerard - University of IowaAurora MaglioccaGiovanni VitaleLinda MussoniJonathan Montomoli - Ospedale Infermi di RiminiMatteo SubertAlessandra PontiSavino Spadaro - University of FerraraGiancarla Poli - Ospedale Papa Giovanni XXIIIFrancesco Casola - Harvard UniversityRoberta Garberi - Azienda Ospedaliera San GerardoAndrea Restivo - Azienda Ospedaliera San GerardoDavide Raimondi CominesiMarco Giani - University of Milano-BicoccaVanessa Zambelli - University of Milano-BicoccaGiuseppe Foti - University of Milano-BicoccaJohn G. Laffey - Ollscoil na Gaillimhe – University of GalwayMaurizio Cereda - Massachusetts General HospitalEmanuele Rezoagli - Azienda Ospedaliera San Gerardo
- Resource Type
- Dataset
- DOI
- 10.6084/m9.figshare.c.8540866
- Publisher
- figshare
- Language
- English
- Date published
- 06/16/2026
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9985243574002771
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