Unveiling Sex Differences in Severe Acute COPD Exacerbations requiring ICU admission: Evidence from a French Cohort.

BACKGROUND: Data on sex differences during acute exacerbations of chronic obstructive pulmonary disease (COPD) management and mortality in the intensive care unit (ICU) are scarce. This study aimed to describe and compare sex differences in management and their impact on mortality. METHODS: We conducted a monocentric retrospective cohort study on all patients admitted to our ICU between 2015 and 2022 for a severe acute exacerbation of COPD. Logistic multivariate regression analysis was performed. RESULTS: A total of 508 patients were included, of whom 331 (65.2%) were males and 177 (34.8%) females. Female patients had a higher proportion of severe COPD (GOLD stage ≥ 3) than males (59.3% vs. 54.4%, p=0.032), whereas males exhibited significantly more cardiovascular comorbidities. Three-month mortality was 19.3% in males and 18.6% in females (p=0.84). In multivariate analysis, factors independently associated with 3-month mortality were older age (HR per year = 1.04, p=0.001), immunodeficiency (HR = 1.66, p=0.022), higher Performance Status (HR per point = 1.68, p<0.001), long-term oxygen therapy (HR = 1.80, p=0.006), and invasive mechanical ventilation (HR = 2.59, 95% CI 1.34-5.01, p=0.05). Sex was not associated with 3-month mortality (p=0.5). CONCLUSIONS: Despite distinct phenotypes between males and females, management, and outcomes of severe COPD exacerbations in ICU were similar, underscoring the need to better understand sex-related determinants in critical COPD care.