Jing Sha1, Guoqiang Qie1, Qingchun Yao1, Wenqing Sun2, Cuiyan Wang3, Zhongfa Zhang4, Xingguang Wang5, Peng Wang1, Jinjiao Jiang1, Xue Bai1, Yufeng Chu1, Mei Meng6. 1. Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China. 2. Department of Intensive Care Unit, Shandong Provincial Chest Hospital, Jinan, China. 3. Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, China. 4. Jinan Infectious Diseases Hospital, Shandong University, Jinan, China. 5. Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China. 6. Department of Critical Care Medicine, Ruijin Hospital, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
Background: Coronavirus disease-2019 (COVID-19) epidemic is spreading globally. Sex differences in the severity and mortality of COVID-19 emerged. This study aims to describe the impact of sex on outcomes in COVOD-19 with a special focus on the effect of estrogen. Methods: We performed a retrospective cohort study which included 413 patients (230 males and 183 females) with COVID-19 from three designated hospitals in China with a follow up time from January 31, 2020, to April 17, 2020. Women over 55 were considered as postmenopausal patients according to the previous epidemiological data from China. The interaction between age and sex on in-hospital mortality was determined through Cox regression analysis. In addition, multivariate Cox regression models were performed to explore risk factors associated with in-hospital mortality of COVID-19. Results: Age and sex had significant interaction for the in-hospital mortality (P < 0.001). Multivariate Cox regression showed that age (HR 1.041, 95% CI 1.009-1.073, P = 0.012), male sex (HR 2.033, 95% CI 1.007-2.098, P = 0.010), the interaction between age and sex (HR 1.118, 95% CI 1.003-1.232, P = 0.018), and comorbidities (HR 9.845, 95% CI 2.280-42.520, P = 0.002) were independently associated with in-hospital mortality of COVID-19 patients. In this multicentre study, female experienced a lower fatality for COVID-19 than male (4.4 vs. 10.0%, P = 0.031). Interestingly, stratification by age group revealed no difference in-hospital mortality was noted in women under 55 compared with women over 55 (3.8 vs. 5.2%, P = 0.144), as well as in women under 55 compared with the same age men (3.8 vs. 4.0%, P = 0.918). However, there was significantly difference in women over 55 with men of the same age group (5.2 vs. 21.0%, P = 0.007). Compared with male patients, female patients had higher lymphocyte (P < 0.001) and high-density lipoprotein (P < 0.001), lower high sensitive c reaction protein level (P < 0.001), and lower incidence rate of acute cardiac injury (6.6 vs. 13.5%, P = 0.022). Conclusion: Male sex is an independent risk factor for COVID-19 in-hospital mortality. Although female mortality in COVID-19 is lower than male, it might not be directly related to the effect of estrogen. Further study is warranted to identify the sex difference in COVID-19 and mechanisms involved.
Background: Coronavirus disease-2019 (COVID-19) epidemic is spreading globally. Sex differences in the severity and mortality of COVID-19 emerged. This study aims to describe the impact of sex on outcomes in COVOD-19 with a special focus on the effect of estrogen. Methods: We performed a retrospective cohort study which included 413 patients (230 males and 183 females) with COVID-19 from three designated hospitals in China with a follow up time from January 31, 2020, to April 17, 2020. Women over 55 were considered as postmenopausal patients according to the previous epidemiological data from China. The interaction between age and sex on in-hospital mortality was determined through Cox regression analysis. In addition, multivariate Cox regression models were performed to explore risk factors associated with in-hospital mortality of COVID-19. Results: Age and sex had significant interaction for the in-hospital mortality (P < 0.001). Multivariate Cox regression showed that age (HR 1.041, 95% CI 1.009-1.073, P = 0.012), male sex (HR 2.033, 95% CI 1.007-2.098, P = 0.010), the interaction between age and sex (HR 1.118, 95% CI 1.003-1.232, P = 0.018), and comorbidities (HR 9.845, 95% CI 2.280-42.520, P = 0.002) were independently associated with in-hospital mortality of COVID-19patients. In this multicentre study, female experienced a lower fatality for COVID-19 than male (4.4 vs. 10.0%, P = 0.031). Interestingly, stratification by age group revealed no difference in-hospital mortality was noted in women under 55 compared with women over 55 (3.8 vs. 5.2%, P = 0.144), as well as in women under 55 compared with the same age men (3.8 vs. 4.0%, P = 0.918). However, there was significantly difference in women over 55 with men of the same age group (5.2 vs. 21.0%, P = 0.007). Compared with male patients, female patients had higher lymphocyte (P < 0.001) and high-density lipoprotein (P < 0.001), lower high sensitive c reaction protein level (P < 0.001), and lower incidence rate of acute cardiac injury (6.6 vs. 13.5%, P = 0.022). Conclusion: Male sex is an independent risk factor for COVID-19 in-hospital mortality. Although female mortality in COVID-19 is lower than male, it might not be directly related to the effect of estrogen. Further study is warranted to identify the sex difference in COVID-19 and mechanisms involved.
Authors: Fiona C McGillicuddy; Margarita de la Llera Moya; Christine C Hinkle; Michelle R Joshi; Elise H Chiquoine; Jeffrey T Billheimer; George H Rothblat; Muredach P Reilly Journal: Circulation Date: 2009-02-16 Impact factor: 29.690
Authors: Ibrahim G Alghamdi; Issam I Hussain; Shaia S Almalki; Mohamed S Alghamdi; Mansour M Alghamdi; Mohammed A El-Sheemy Journal: Int J Gen Med Date: 2014-08-20
Authors: Joshua P Metlay; Grant W Waterer; Ann C Long; Antonio Anzueto; Jan Brozek; Kristina Crothers; Laura A Cooley; Nathan C Dean; Michael J Fine; Scott A Flanders; Marie R Griffin; Mark L Metersky; Daniel M Musher; Marcos I Restrepo; Cynthia G Whitney Journal: Am J Respir Crit Care Med Date: 2019-10-01 Impact factor: 21.405
Authors: J Zhang; X Wang; X Jia; J Li; K Hu; G Chen; J Wei; Z Gong; C Zhou; H Yu; M Yu; H Lei; F Cheng; B Zhang; Y Xu; G Wang; W Dong Journal: Clin Microbiol Infect Date: 2020-04-15 Impact factor: 8.067
Authors: Mohammed Al-Jarallah; Rajesh Rajan; Raja Dashti; Ahmad Al Saber; Peter A Brady; Hassan Abdelnaby; Moudhi Alroomi; Wael Aboelhassan; Mohammed Abdullah; Noor AlNasrallah; Bader Al-Bader; Haya Malhas; Maryam Ramadhan; Naser Alotaibi; Mohammad Al Saleh; Farah Almutairi; Kobalava D Zhanna Journal: Ann Med Surg (Lond) Date: 2022-06-20
Authors: Nikita Abramenko; Fréderic Vellieux; Petra Tesařová; Zdeněk Kejík; Robert Kaplánek; Lukáš Lacina; Barbora Dvořánková; Daniel Rösel; Jan Brábek; Adam Tesař; Milan Jakubek; Karel Smetana Journal: Int J Mol Sci Date: 2021-06-18 Impact factor: 5.923
Authors: César Fernández-de-Las-Peñas; José D Martín-Guerrero; Óscar J Pellicer-Valero; Esperanza Navarro-Pardo; Víctor Gómez-Mayordomo; María L Cuadrado; José A Arias-Navalón; Margarita Cigarán-Méndez; Valentín Hernández-Barrera; Lars Arendt-Nielsen Journal: J Clin Med Date: 2022-01-14 Impact factor: 4.241
Authors: Joseph M Unger; Riha Vaidya; Kathy S Albain; Michael LeBlanc; Lori M Minasian; Carolyn C Gotay; N Lynn Henry; Michael J Fisch; Shing M Lee; Charles D Blanke; Dawn L Hershman Journal: J Clin Oncol Date: 2022-02-04 Impact factor: 50.717