Sex differences in clinical characteristics and risk factors for mortality among severe patients with COVID-19: a retrospective study

Abstract

The coronavirus disease 2019 (COVID-19) became a global pandemic. Males, compared to females, seem to be more susceptible to COVID-19, but related evidence is scarce, especially in severe patients. We explored sex differences in clinical characteristics and potential risk factors for mortality in severe COVID-19 patients. In this retrospective cohort study, we included all severe COVID-19 patients admitted to Eastern Renmin Hospital of Wuhan University, Wuhan, China, with a definitive clinical outcome as of Apr 10, 2020. Of the included 651 patients, 332 were male, and 319 were female. Males and females did not differ in age and underlying comorbidities. Males were more likely than females to report fever and develop serious complications, including acute respiratory distress syndrome, secondary infection, acute cardiac injury, coagulopathy, acute kidney injury and arrhythmia. Further, males had much higher mortality relative to females. Multivariable regression showed neutrophilia (odds ratio 6.845, 95% CI 1.227-38.192, p=0.028), thrombocytopenia (19.488, 3.030-25.335, p=0.002), hypersensitive troponin I greater than 0.04 pg/mL (6.058, 1.545-23.755, p=0.010), and procalcitonin greater than 0.1 ng/mL (6.350, 1.396-28.882, p=0.017) on admission were associated with inhospital death. With either of these risk factors, the cumulative survival rate was relatively lower in males than in females. In conclusion, males are more likely than females to develop serious complications and progress to death. The potential risk factors of neutrophilia, thrombocytopenia, hypersensitive troponin I greater than 0.04 pg/mL and procalcitonin more than 0.1 ng/mL may help clinicians to identify patients with poor outcomes at an early stage, especially in males.

Sex and gender differences in COVID-19: More to be learned!

“…Several studies have been recently published showing the sex-specific differences in the prevalence and comorbidity profile between men and women infected with COVID-19 ( Figure 1 ) [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. Some studies reported a higher incidence of COVID-19 infection in men [ 3 , 4 , 11 , 13 ], while other studies did not show a difference in incidence of COVID-19 infections [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [12] , [13] , [14] , [15] ]. This could be attributed to higher risk of exposure in men [ 8 ], access to healthcare and testing availability among other factors [ 13 ].…”

“…Some studies reported a higher incidence of COVID-19 infection in men [ 3 , 4 , 11 , 13 ], while other studies did not show a difference in incidence of COVID-19 infections [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [12] , [13] , [14] , [15] ]. This could be attributed to higher risk of exposure in men [ 8 ], access to healthcare and testing availability among other factors [ 13 ]. Not only do the reported comorbidities differ between men and women, but they also differ based on the population being studied ( Figure 1 ) [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ].…”

“…This could be attributed to higher risk of exposure in men [ 8 ], access to healthcare and testing availability among other factors [ 13 ]. Not only do the reported comorbidities differ between men and women, but they also differ based on the population being studied ( Figure 1 ) [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. In general, men had higher prevalence of smoking, lung disease and cardiovascular disease, while women had higher prevalence of obesity and kidney disease ( Table 1 ).…”

“…Interestingly, even after adjusting for these comorbidities, men still had higher rates of mortality or severe infection compared to women [ [4] , [5] , [6] , 13 ]. In addition to mortality, studies have shown that men with COVID-19 were at higher risk for intensive care unit (ICU) admissions and were more likely to have disease progression and undergo mechanical ventilation [ 8 , 9 , 12 , 13 , 15 ]. In a study by Iaccarino et al, male sex was a predictor for ICU admissions in COVID-19 patients [ 9 ].…”

“…The novel coronavirus disease (COVID-19) pandemic has affected millions of patients in the United States (US) and worldwide [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. Studies have shown that older age and a higher number of comorbidities are associated with higher infection severity and mortality in patients with COVID-19 infection, partially explaining the higher severity and case fatality of COVID-19 infections observed in men; with men being twice as likely to die from COVID-19 compared with women [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. However, data also show that differences in the disease severity and outcomes exist based on sex and gender, independent of age and comorbidity profiles, not only in the US but also in various countries across the globe [ [4] , [5] , [6] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ].…”