PMON201 The Impact of Menopause on Poor Outcomes in Hospitalized Patients with COVID-19 Infection

Abstract

Background Studies evaluating risk factors for poor outcomes with COVID-19 infection report gender variation. Impact of estrogen on immune regulation may be one factor contributing to better outcomes in women. This study evaluates the impact of menopausal status and other risk factors on health outcomes in women hospitalized with COVID-19 infection. Methods Data from 1863 non-pregnant women admitted to the Lifespan Hospital System in Rhode Island with COVID-19 infection during the first wave (March 1 - June 30, 2020) and second wave (July 1, 2020 - February 28, 2021) were analyzed. Subjects were categorized as pre-menopausal (age less than 45 years), perimenopausal (age 45 to 55 years), and post-menopausal (age greater than 55 years). Multivariate models to look for risk factors associated with severe illness (i.e. intensive care unit admissions, mechanical ventilation and death) controlled for menopause status, race/ethnicity, insurance type, wave of COVID-19, body mass index, diabetes (DM), hyperglycemia, hypertension (HTN), pulmonary disease, cardiovascular disease (CVD) and chronic kidney disease (CKD). Results In our cohort, pre-, peri- and pre, peri and post- menopausal status represented 12.8, 10.4 and 76.8% of the study population, respectively. The mean (± SD) age was 67.57 ±18.0 with 61.4% White/Caucasian, 20% Hispanic/Latino and 1.7% Black. 98.4% had commercial or government-sponsored health insurance. Hyperglycemia (Blood glucose > 180mg/dL on two occurrences) was noted in 26.8% of hospitalized women. Compared to pre- and peri- menopausal status, post- menopausal status was associated with a higher prevalence of Hyperglycemia (OR 1.59 [1.23-2.07]), DM 1.90 (1.50-2.42), HTN 5.06 (4.02-6.37), Pulmonary disease 1.35 (1.07-1.70) and CKD 3.7 (2.58-5.42). Post-menopausal status was also associated with higher mortality (OR 8.6 [2.7-27.6]), severe illness (OR 5.7 [1.3-23.9]), readmission (OR 1.5 [1.04-2.2]) and longer length of hospital stay (OR 1.6 [1.2-2.2]). Adjusted model identified, hyperglycemia (OR 14.8 [4.5-48.8]) and first wave (OR 2.7 [1.1-6.4]) to be independent risk factors for severe illness in post-menopausal women admitted to the hospital with COVID -19 infection. Conclusion While patients with comorbidities are known to be at greater risk for complications related to COVID-19 infection, menopausal status has rarely been considered a risk factor. Recognizing underlying risk factors in females, particularly menopausal females with COVID-19, can help clinicians attempt to identify patients at a higher risk of COVID-19 complications and drive early, more aggressive interventions to mitigate risk in this population. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Incidence and Outcomes Associated with Menopausal Status in COVID-19 Patients: A Systematic Review and Meta-analysis

“…Of the 789 remaining papers, 34 were reviewed in full text. Finally, 12 studies were included in the present systematic review 15 16 17 18 19 20 21 22 23 24 25 26 ( Fig. 1 ) and 6 were included in the meta-analysis.…”

“…1 ) and 6 were included in the meta-analysis. 15 16 17 18 19 20 21 22 23 24 25 The total number of patients in the 12 included studies was 331,821, ranging from 147 to 152,637. Seven studies were conducted in Asia (five in China 15 16 20 22 23 and two in India 17 21 ), one each in Canada, 18 United States, 25 Italy, 24 and United Kingdom, 26 and one was a multicenter study.…”

“… 15 16 17 18 19 20 21 22 23 24 25 The total number of patients in the 12 included studies was 331,821, ranging from 147 to 152,637. Seven studies were conducted in Asia (five in China 15 16 20 22 23 and two in India 17 21 ), one each in Canada, 18 United States, 25 Italy, 24 and United Kingdom, 26 and one was a multicenter study. 19 All but one cross-sectional study 15 had a retrospective cohort design.…”