Characterization of Clinical Features of Hospitalized Patients Due to the SARS-CoV-2 Infection in the Absence of Comorbidities Regarding the Sex: An Epidemiological Study of the First Year of the Pandemic in Brazil

Abstract

The male sex, due to the presence of genetic, immunological, hormonal, social, and environmental factors, is associated with higher severity and death in Coronavirus Disease (COVID)-19. We conducted an epidemiological study to characterize the COVID-19 clinical profile, severity, and outcome according to sex in patients with the severe acute respiratory syndrome (SARS) due to the fact of this disease. We carried out an epidemiological analysis using epidemiological data made available by the OpenDataSUS, which stores information about SARS in Brazil. We recorded the features of the patients admitted to the hospital for SARS treatment due to the presence of COVID-19 (in the absence of comorbidities) and associated these characteristics with sex and risk of death. The study comprised 336,463 patients, 213,151 of whom were men. Male patients presented a higher number of clinical signs, for example, fever (OR = 1.424; 95%CI = 1.399–1.448), peripheral arterial oxygen saturation (SpO2) < 95% (OR = 1.253; 95%CI = 1.232–1.274), and dyspnea (OR = 1.146; 95%CI = 1.125–1.166) as well as greater need for admission in intensive care unit (ICU, OR = 1.189; 95%CI = 1.168–1.210), and the use of invasive ventilatory support (OR = 1.306; 95%CI = 1.273–1.339) and noninvasive ventilatory support (OR = 1.238; 95%CI = 1.216–1.260) when compared with female patients. Curiously, the male sex was associated only with a small increase in the risk of death when compared with the female sex (OR = 1.041; 95%CI = 1.023–1.060). We did a secondary analysis to identify the main predictors of death. In that sense, the multivariate analysis enabled the prediction of the risk of death, and the male sex was one of the predictors (OR = 1.101; 95%CI = 1.011–1.199); however, with a small effect size. In addition, other factors also contributed to this prediction and presented a great effect size, they are listed below: older age (61–72 years old (OR = 15.778; 95%CI = 1.865–133.492), 73–85 years old (OR = 31.978; 95%CI = 3.779–270.600), and +85 years old (OR = 68.385; 95%CI = 8.164–589.705)); race (Black (OR = 1.247; 95%CI = 1.016–1.531), Pardos (multiracial background; OR = 1.585; 95%CI = 1.450–1.732), and Indigenous (OR = 3.186; 95%CI = 1.927–5.266)); clinical signs (for instance, dyspnea (OR = 1.231; 95%CI = 1.110–1.365) and SpO2 < 95% (OR = 1.367; 95%CI = 1.238–1.508)); need for admission in the ICU (OR = 3.069; 95%CI = 2.789–3.377); and for ventilatory support (invasive (OR = 10.174; 95%CI = 8.803–11.759) and noninvasive (OR = 1.609; 95%CI = 1.438–1.800)). In conclusion, in Brazil, male patients tend to present the phenotype of higher severity in COVID-19, however, with a small effect on the risk of death.

Profile of coronavirus disease enlightened asthma as a protective factor against death: An epidemiology study from Brazil during the pandemic

“…We obtained the data between 17 February 2020 and 10 October 2021. In addition, the dataset used in the present study was published and validated in other studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…Other coronavirus outbreaks, such as the SARS Coronavirus 1 (SARS-CoV-1) and the Middle East Respiratory Syndrome (MERS) outbreaks, showed similar results as the present pandemic ( 39 , 40 ). Innate and adaptive endocrinological and immunological differences appear to be the main related mechanisms ( 32 , 39 ). Among the adaptive responses, female patients have a more significant amount of cluster of differentiation 4 (CD4)+ T cells, a cellular activity of cluster of differentiation 8 (CD8)+ T cells, and even greater antibody production than male patients ( 32 , 39 , 41 ).…”

“…Innate and adaptive endocrinological and immunological differences appear to be the main related mechanisms ( 32 , 39 ). Among the adaptive responses, female patients have a more significant amount of cluster of differentiation 4 (CD4)+ T cells, a cellular activity of cluster of differentiation 8 (CD8)+ T cells, and even greater antibody production than male patients ( 32 , 39 , 41 ). Female patients also produce more type 1 interferon, a potent antiviral cytokine.…”

“…It is important to note that simple protective habits, such as washing your hands after going to the bathroom or less exposure, are more common in females, and another factor in explaining or at least contributing to the protection that women have against infectious diseases, but that fact did not justify the mortality faced whenever compared to males and females already infected by the virus ( 43 ). Despite their lower mortality ( 32 ), female patients have a more significant correlation with the development of post-COVID syndrome ( 43 ).…”

Relation between Orotracheal Intubation, Inflammatory Markers, Breathing and Voice in Post-COVID-19

“…An epidemiological analysis based on the data provided by OpenDataSUS uncovered that most patients were male and that they tended to have more severe COVID-19 89 . Male gender was an independent predictor of in-hospital mortality, and the mortality rate among male patients with SARS-CoV-2 was 2.8 times higher when compared to females 90 .…”