Association of Sex with Clinical Outcomes in COVID-19 Patients: A Retrospective Analysis of 1190 Cases

Overview

Journal Respir Med

Publisher Elsevier

Specialty Pulmonary Medicine

Date 2020 Oct 3

PMID 33010731

Citations 11

Authors

Jiao Liu

Lidi Zhang

Yizhu Chen

Zhixiong Wu

Xuan Dong

Jean-Louis Teboul

Sheng Zhang

Xiaofei Ye

Yongan Liu

Tao Wang

Hangxiang Du

Wenzhe Li

Dechang Chen

Affiliations

Soon will be listed here.

Abstract

Background: The outbreak of COVID-19 caused by SARS-CoV-2 has been a pandemic. The objective of our study was to explore the association between sex and clinical outcomes in patients with COVID-19.

Methods: Detailed clinical data including clinical characteristics, laboratory tests, imaging features and treatments of 1190 cases of adult patients with confirmed COVID-19 were retrospectively analyzed. Associations between sex and clinical outcomes were identified by multivariable Cox regression analysis.

Results: There were 635 (53.4%) male and 555 (46.6%) female patients in this study. Higher rates of acute kidney injury (5.5% vs. 2.9%, p = 0.026), acute cardiac injury (9.1% vs. 4.3%, p = 0.001), and disseminated intravascular coagulation (2.5% vs. 0.7%, P = 0.024) were observed in males. Compared with female patients, male patients with COVID-19 had a higher inhospital mortality rate (15.7% vs. 10.3%, p = 0.005). However, Cox regression analysis showed that sex did not influence inhospital mortality of COVID-19 patients.

Conclusions: Male sex was associated with a worse prognosis of COVID-19, but it seems not to be an independent prognostic factor.

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References

Saltiel A, Olefsky J . Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest. 2017; 127(1):1-4. PMC: 5199709. DOI: 10.1172/JCI92035. View

Chen L, Li X, Chen M, Feng Y, Xiong C . The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res. 2020; 116(6):1097-1100. PMC: 7184507. DOI: 10.1093/cvr/cvaa078. View

Knowlton A, Lee A . Estrogen and the cardiovascular system. Pharmacol Ther. 2012; 135(1):54-70. PMC: 5688223. DOI: 10.1016/j.pharmthera.2012.03.007. View

Klein S . Sex influences immune responses to viruses, and efficacy of prophylaxis and treatments for viral diseases. Bioessays. 2012; 34(12):1050-9. PMC: 4120666. DOI: 10.1002/bies.201200099. View

van den Berg R, Haenen G, van den Berg H, Bast A . Nuclear factor-kappaB activation is higher in peripheral blood mononuclear cells of male smokers. Environ Toxicol Pharmacol. 2001; 9(4):147-151. DOI: 10.1016/s1382-6689(00)00070-3. View

Montt-Guevara M, Palla G, Spina S, Bernacchi G, Cecchi E, Campelo A . Regulatory effects of estetrol on the endothelial plasminogen pathway and endothelial cell migration. Maturitas. 2017; 99:1-9. DOI: 10.1016/j.maturitas.2017.02.005. View

Okusa M, Davenport A . Reading between the (guide)lines--the KDIGO practice guideline on acute kidney injury in the individual patient. Kidney Int. 2013; 85(1):39-48. PMC: 3877708. DOI: 10.1038/ki.2013.378. View

Ranieri V, Rubenfeld G, Thompson B, Ferguson N, Caldwell E, Fan E . Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. DOI: 10.1001/jama.2012.5669. View

The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team . The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) - China, 2020. China CDC Wkly. 2021; 2(8):113-122. PMC: 8392929. View

10.

Di Stadio A, Ricci G, Greco A, De Vincentiis M, Ralli M . Mortality rate and gender differences in COVID-19 patients dying in Italy: A comparison with other countries. Eur Rev Med Pharmacol Sci. 2020; 24(8):4066-4067. DOI: 10.26355/eurrev_202004_20980. View

11.

Levi M, Sivapalaratnam S . Disseminated intravascular coagulation: an update on pathogenesis and diagnosis. Expert Rev Hematol. 2018; 11(8):663-672. DOI: 10.1080/17474086.2018.1500173. View

12.

Khan D, Ahmed S . The Immune System Is a Natural Target for Estrogen Action: Opposing Effects of Estrogen in Two Prototypical Autoimmune Diseases. Front Immunol. 2016; 6:635. PMC: 4701921. DOI: 10.3389/fimmu.2015.00635. View

13.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J . A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733. PMC: 7092803. DOI: 10.1056/NEJMoa2001017. View

14.

Gomez H, Ince C, De Backer D, Pickkers P, Payen D, Hotchkiss J . A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 2013; 41(1):3-11. PMC: 3918942. DOI: 10.1097/SHK.0000000000000052. View

15.

Varga Z, Flammer A, Steiger P, Haberecker M, Andermatt R, Zinkernagel A . Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020; 395(10234):1417-1418. PMC: 7172722. DOI: 10.1016/S0140-6736(20)30937-5. View

16.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J . Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. PMC: 7092819. DOI: 10.1056/NEJMoa2002032. View

17.

Kritas S, Ronconi G, Caraffa A, Gallenga C, Ross R, Conti P . Mast cells contribute to coronavirus-induced inflammation: new anti-inflammatory strategy. J Biol Regul Homeost Agents. 2020; 34(1):9-14. DOI: 10.23812/20-Editorial-Kritas. View

18.

Hu B, Huang S, Yin L . The cytokine storm and COVID-19. J Med Virol. 2020; 93(1):250-256. PMC: 7361342. DOI: 10.1002/jmv.26232. View

19.

Welsh P, Woodward M, Rumley A, Lowe G . Associations of plasma pro-inflammatory cytokines, fibrinogen, viscosity and C-reactive protein with cardiovascular risk factors and social deprivation: the fourth Glasgow MONICA study. Br J Haematol. 2008; 141(6):852-61. DOI: 10.1111/j.1365-2141.2008.07133.x. View

20.

Flanagan K, Fink A, Plebanski M, Klein S . Sex and Gender Differences in the Outcomes of Vaccination over the Life Course. Annu Rev Cell Dev Biol. 2017; 33:577-599. DOI: 10.1146/annurev-cellbio-100616-060718. View