Considering how biological sex impacts immune responses and COVID-19 outcomes

Scully, Eileen P.; Haverfield, Jenna; Ursin, Rebecca L.; Tannenbaum, Cara; Klein, Sabra L.

doi:10.1038/s41577-020-0348-8

Cited by 824 publications

(958 citation statements)

References 115 publications

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“…Previous analysis of epidemiological characteristics also showed that the prevalence and mortality among males with COVID-19 were obviously higher than those among females [10,11]. Possible explanations are the effects of different hormones and the fact that smoking, which is much more prevalent in the male population than in the female population, leads to an upregulation expression of angiotensin-converting enzyme 2 (ACE2), which may serve as a potential invasion receptor for SARS-CoV-2 [12][13][14]. The results showed that patients in severe conditions were overwhelmingly older than 50 years and that critical patients were notably older than those with severe conditions, indicating that older patients are at a higher risk of requiring critical care, which is consistent with the current study's ndings [15].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Troponin I Associated with Poor Prognosis and Death Risk in 726 Severe and Critical COVID-19 Patients: A Retrospective Cohort Study

Chen

Marmar

et al. 2020

Preprint

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Background: A few patients with coronavirus disease 2019 (COVID-19) may progress into irreparable outcomes. Early identification of patients with serious symptoms who may develop critical illness and even death is of considerable importance for personalizing treatment and balancing medical resources.Methods: In this retrospective study, demographic, clinical characteristics and laboratory tests from 726 patients with serious COVID-19 from Tongji Hospital (Wuhan, China) were analyzed. The standards for the serious type are guided by the Chinese management guideline for COVID-19. Patients were classified into critical group (174 cases) and severe group (552 cases) based on whether the composite endpoint was reached, and the former group was divided into the survivors (47 cases) and non-survivors (127 cases). Univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to investigate the risk factors associated with poor prognosis and mortality outcomes.Results: Male patients accounted for 62.1% and 51.6% in the critical group and severe group, with a median age of 68 and 65 years, respectively. Among critical cases there was a higher prevalence of chronic obstructive lung disease (p = 0.029) and chest distress (p = 0.040) than in severe cases. In the multivariable analysis, the risk factors associated with poor prognosis in severe cases were advanced age (p = 0.002), high respiratory rate (RR) (p < 0.0001), high lactate dehydrogenase (LDH) level (p = 0.021), high hypersensitive cardiac troponin I (hs-cTnI) level (p < 0.0001), and low platelet counts (p = 0.005) at admission. In the adjusted models, higher mortality outcomes in critical patients were associated with high hs-cTnI level (p = 0.037). By plotting ROC curves of different indices, hs-cTnI and LDH were found to be predictive factors for poor prognosis in patients with severe COVID-19.Conclusions: For the risk assessment of serious COVID-19 patients on admission, advanced age, high level of RR, LDH, hs-cTnI, and low platelet counts, constitute important risk factors for poor prognosis in severe cases, and the hs-cTnI level can be helpful in predicting fatal outcomes in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Cardiac Troponin I Associated with Poor Prognosis and Death Risk in 726 Severe and Critical COVID-19 Patients: A Retrospective Cohort Study

Chen

Marmar

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Although there were few clinical data for sex difference in immunity after COVID-19, previous data for response to other viral infection, vaccines, or autoimmunity suggested that immune responses to COVID-19 may be different between sexes. Women generally have greater antibody production response to viral infection, which is associated with estrogen effect or inherent difference in B cell response after infection [7,15]. In addition, there were evidences for sex differences in cytokine production or gene expression in innate cell subsets [7].…”

Section: Discussionmentioning

confidence: 99%

“…The Global Health 50/50 initiative, using data from > 20 countries, recently reported higher mortality among men than among women [6]. Previous studies have suggested that sex differences in the prognosis of COVID-19 patients may be associated with the difference in the expression of angiotensin-converting enzyme-2 (ACE-2), immune responses, comorbidities, socioeconomic factors, or environmental factors, such as smoking or alcohol consumption [6][7][8]. However, there were no de nite conclusions regarding whether sex differences in COVID-19 patients were associated with unde ned etiologies or results of statistical probability.…”

Section: Introductionmentioning

confidence: 99%

Effect of sex on clinical outcomes in COVID-19 patients: a population-based study

Kang

Kim

Park

et al. 2020

Preprint

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Background Previous studies have reported the association between sex and clinical outcomes; however, the most relevant results were obtained as part of analyses evaluating other prognostic factors. This study aimed to evaluate the association between sex and clinical outcomes in patinets with COVID-19 using a population-based dataset. Methods This retrospective study utilized claims data from the Health Insurance Review & Assessment Service of Korea. Confirmed patients were included among all participants who underwent COVID-19 testing. Diseases including COVID-19 were defined using International Classification of Diseases, 10th revision (ICD-10). During follow-up, clinical outcomes except death were defined using Electronic Data Interchange or ICD-10 codes from the dataset. Results A total of 234,427 patients underwent laboratory testing for COVID-19. Finally, 7327 patients were included; of these, 2964 were men and 4363 were women. The proportions of patients with diabetes mellitus or hypertension as major comorbidities were higher among men than among women of the some age groups, but there were no significant differences in the Charlson comorbidity index score between men and women in same age group. Survival and clinical outcomes including acute kidney injury, the use of inotropes, mechanical ventilator, and cardiac events were greater in men than women. The mortality rate was the highest for the populations aged 50–64 or ≥ 65 years. Subgroup analyses for age, diabetes mellitus, or hypertension showed favorable results for patient survival or clinical outcomes in women compared to men. Conclusion Our population-based study showed that female patients with COVID-19 were associated with favorable outcomes, including survival. The impact of sex was more evident in population aged 50–64 or ≥ 65 years.

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“…We also identified significant risk factors associated with the identified clusters using a multinomial logit model. It is shown that different age and sex distributions in the U.S. counties impact differentially COVID-19 mortality and severity 57,58 . Race is also a factor that leads to heterogeneity.…”

Section: Here]mentioning

confidence: 99%

County-Level Longitudinal Clustering of COVID-19 Mortality to Incidence Ratio in the United States

Vahabi¹,

Salehi²,

Duarte³

et al. 2020

Preprint

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Abstract Background: As of June 3, 2020, the mortality to incidence ratio (MIR) of COVID-19 was 5.8%. We utilized a longitudinal model-based clustering system based on the disease trajectories over time.Methods: County-level COVID-19 cases and deaths (March-June 2020), and a set of potential risk factors were collected for 3050 U.S. counties. We used growth mixture models to identify clusters of counties exhibiting similar COVID-19 MIR growth trajectories and risk-factors over time. Results: We identified clusters 1 (rural-areas of IA, NC, OK, VA, FL, GA, LA, OH states), and 7 (rural-areas of AR, CO, GA, KS, NE, TN, TX states) as the so-called “more vulnerable” clusters. Tuberculosis (OR=1.3), drug use disorder (OR=1.1), and particulate matter (OR=1.1) were significantly associated with increased odds of being in a more vulnerable cluster. Heart complications and cancer were the main risk factors increasing the COVID-19 MIR (range: 0.08%-0.72% MIR↑).Conclusion: We identified two county-clusters exhibiting the highest COVID-19 MIR trajectories, indicating that enhancing the capacity and access to healthcare resources would be key to successfully manage COVID-19 in these “vulnerable” clusters. These findings provide insights for public health policymakers on the groups of people and locations they need to pay particular attention while managing the COVID-19 epidemic.

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Considering how biological sex impacts immune responses and COVID-19 outcomes

Cited by 824 publications

References 115 publications

Cardiac Troponin I Associated with Poor Prognosis and Death Risk in 726 Severe and Critical COVID-19 Patients: A Retrospective Cohort Study

Cardiac Troponin I Associated with Poor Prognosis and Death Risk in 726 Severe and Critical COVID-19 Patients: A Retrospective Cohort Study

Effect of sex on clinical outcomes in COVID-19 patients: a population-based study

County-Level Longitudinal Clustering of COVID-19 Mortality to Incidence Ratio in the United States

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