Sex-related differences in patients with coronavirus disease 2019: results of the Cardio-COVID-Italy multicentre study

Abstract

IntroductionThe role of sex compared to comorbidities and other prognostic variables in patients with coronavirus disease (COVID-19) is unclear.MethodsThis is a retrospective observational study on patients with COVID-19 infection, referred to 13 cardiology units. The primary objective was to assess the difference in risk of death between the sexes. The secondary objective was to explore sex-based heterogeneity in the association between demographic, clinical and laboratory variables, and patients’ risk of death.ResultsSeven hundred and one patients were included: 214 (30.5%) women and 487 (69.5%) men. During a median follow-up of 15 days, deaths occurred in 39 (18.2%) women and 126 (25.9%) men. In a multivariable Cox regression model, men had a nonsignificantly higher risk of death vs. women (P = 0.07).The risk of death was more than double in men with a low lymphocytes count as compared with men with a high lymphocytes count [overall survival hazard ratio (OS-HR) 2.56, 95% confidence interval (CI) 1.72–3.81]. In contrast, lymphocytes count was not related to death in women (P = 0.03).Platelets count was associated with better outcome in men (OS-HR for increase of 50 × 103 units: 0.88 95% CI 0.78–1.00) but not in women. The strength of association between higher PaO2/FiO2 ratio and lower risk of death was larger in women (OS-HR for increase of 50 mmHg/%: 0.72, 95% CI 0.59–0.89) vs. men (OS-HR: 0.88, 95% CI 0.80–0.98; P = 0.05).ConclusionsPatients’ sex is a relevant variable that should be taken into account when evaluating risk of death from COVID-19. There is a sex-based heterogeneity in the association between baseline variables and patients’ risk of death.

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years

“…29,[31][32][33][34] Of note, the severity of the disease can be influenced by multiple factors. 35,36 Among patients hospitalized with laboratory confirmed COVID-19, machine learning algorithms identified age, oxygen saturation, PaO 2 /FiO 2 , creatinine clearance and troponin levels as the most relevant variables that predicted outcome. 36…”

“…SARS-CoV-2 infection may also trigger endothelial and microvascular dysfunction that, combined with systemic inflammation, can lead to multiorgan involvement and to a prothrombotic state, with frequent thromboembolic events 29,31–34 . Of note, the severity of the disease can be influenced by multiple factors 35,36 . Among patients hospitalized with laboratory confirmed COVID-19, machine learning algorithms identified age, oxygen saturation, PaO 2 /FiO 2 , creatinine clearance and troponin levels as the most relevant variables that predicted outcome 36 …”

Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on ‘gender cardiovascular diseases’

“…Thus, whether the incidence of COVID-19 related myocardial injury is sex-dependent remains not fully elucidated. 7 – 9 …”

“…In COVID-19, mortality is strongly associated with the presence of myocardial injury (7–40%) 5,6 and cardiovascular diseases play a crucial role in determining the outcome, as preexistent or intercurrent. Thus, whether the incidence of COVID-19 related myocardial injury is sex-dependent remains not fully elucidated 7–9 …”

“…Thus, whether the incidence of COVID-19 related myocardial injury is sex-dependent remains not fully elucidated. [7][8][9] Since the onset of the pandemic, men have appeared to suffer from a respiratory and cardiovascular poorer prognosis, exhibiting more severe and long-lasting disease and symptoms. 10,11 The exact mechanisms of these differences are not completely understood and likely represent a complex mosaic of multiple factors.…”