Trends in Coronavirus Disease 2019 Hospitalization and Prognosis: Gender Effect

Abstract

We here aimed to investigate the impact of gender on the clinical characteristics and laboratory results of patients with coronavirus disease 2019 (COVID-19) and provide clues to the pathological mechanisms underlying COVID-19. A retrospective study was performed. Clinical characteristics, severity of lung infection, laboratory results, and prognoses of patients of different gender were analyzed. A total of 242 patients were finally included. The median age was 58 years (IQR: 40–68), including 54 (22.3%) hospital staffs. Ninety-four (38.8%) were male and 148 (61.1%) were female. The proportion of patients with diabetes was significantly higher in the male group than in the female group (P=0.034). Male patients had a significantly larger proportion of severe lung infection, higher leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, C-reactive protein, and procalcitonin than female. Furthermore, male patients had worse liver, cardiac, and coagulation function than their female counterparts. Male patients with COVID-19 showed more severe inflammation reaction and coagulation dysfunction than female patients. In conclusion, gender is associated with host response to SARS-CoV-2 infection.

Keywords

COVID-19 / gender / blood routine / coagulation function / inflammation

References

[1] GuanWJ, NiZY, HuY, et al.. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720

[2] ZhouF, YuT, DuR, et al.. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in wuhan, China: A retrospective cohort study. Lancet, 2020, 395(10229): 1054-1062

[3] HuangC, WangY, LiX, et al.. Clinical features of patients infected with 2019 novel coronavirus in wuhan, China. Lancet, 2020, 395(10223): 497-506

[4] JinJM, BaiP, HeW, et al.. Gender differences in patients with COVID-19: Focus on severity and mortality. Front Public Health, 2020, 8(152): 1-6

[5] Epidemiology working Group for NCIP Epidemic ResponseChinese Center for Disease ControlPrevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi (Chinese), 2020, 41(2): 145-151

[6] OrtolanA, LorenzinM, FelicettiM, et al.. Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis. Int J Infect Dis, 2020, 99: 496-504

[7] SpagnoloPA, MansonJE, JoffeH. Sex and gender differences in health: What the COVID-19 pandemic can teach us. Ann Intern Med, 2020, 173(5): 385-386

[8] Diagnosis and treatment program of 2019 new coronavirus pneumonia (trial seventh version). (Chinese). 2020 (http://www.nhc.gov.cn/xcs/zhengcwj/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf)

[9] Clinical management of COVID-19. 2020 (https://apps.who.int/iris/rest/bitstreams/1278777/retrieve)

[10] Chinese Research Hospital Association Standing Committee on Infection and Inflammation. Guideline for imaging diagnosis of novel coronavirus(2019-ncov) infected pneumonia (2nd edition 2020). Shoudu Yike Daxue Xuebao (Chinese), 2020, 41(2): 168-173

[11] MohamedMO, GaleCP, KontopantelisE, et al.. Sex differences in mortality rates and underlying conditions for COVID-19 deaths in england and wales. Mayo Clin Proc, 2020, 95(10): 2110-2124

[12] AncaPS, TothPP, KemplerP, et al.. Gender differences in the battle against COVID-19: Impact of genetics, comorbidities, inflammation and lifestyle on differences in outcomes. Int J Clin Pract, 2020, 75(2): e13666

[13] HaitaoT, VermuntJV, AbeykoonJ, et al.. COVID-19 and sex differences: Mechanisms and biomarkers. Mayo Clin Proc, 2020, 95(10): 2189-2203

[14] LiY, JerkicM, SlutskyAS, et al.. Molecular mechanisms of sex bias differences in COVID-19 mortality. Crit Car, 2020, 24(1): 405

[15] GuanWJ, LiangWH, ZhaoY, et al.. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J, 2020, 55(5): 2000547

[16] LaucG, SinclairD. Biomarkers of biological age as predictors of COVID-19 disease severity. Aging (Albany NY), 2020, 12(8): 6490-6491

[17] The Lancet. The gendered dimensions of COVID-19. Lancet, 2020, 395(10231): 1168

[18] MarkleJG, FishEN. Sex matters in immunity. Trends Immunol, 2014, 35(3): 97-104

[19] MaggiE, CanonicaGW, MorettaL. COVID-19: Unanswered questions on immune response and pathogenesis. J Allergy Clin Immunol, 2020, 146(1): 18-22

[20] WakemanL, Al-IsmailS, BentonA, et al.. Robust, routine haematology reference ranges for healthy adults. Int J Lab Hematol, 2007, 29(4): 279-283

[21] QiaoR, YangS, YaoB, et al.. Complete blood count reference intervals and age- and sex-related trends of north China han population. Clin Chem Lab Med, 2014, 52(7): 1025-1032

[22] QinC, ZhouL, HuZ, et al.. Dysregulation of immune response in patients with COVID-19 in wuhan, China. Clin Infect Dis., 2020, 71(15): 762-768

[23] TerposE, Ntanasis-StathopoulosI, ElalamyI, et al.. Hematological findings and complications of COVID-19. Am J Hematol., 2020, 95(7): 834-847

[24] AkhmerovA, MarbanE. COVID-19 and the heart. Circ Res., 2020, 126(10): 1443-1455

[25] TayMZ, PohCM, ReniaL, et al.. The trinity of COVID-19: Immunity, inflammation and intervention. Nat Rev Immunol., 2020, 20(6): 363-374

[26] SalamannaF, MaglioM, LandiniMP, et al.. Platelet functions and activities as potential hematologic parameters related to coronavirus disease 2019 (COVID-19). Platelets, 2020, 31(5): 627-632

[27] WeidhoferC, MeyerE, RistlR, et al.. Dynamic reference intervals for coagulation parameters from infancy to adolescence. Clin Chim Acta, 2018, 482: 124-135

[28] CaiH. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med, 2020, 8(4): e20