Sex-differences in COVID-19 diagnosis, risk factors and disease comorbidities: A large US-based cohort study

Kharroubi, Samer A.; Diab-El-Harake, Marwa

doi:10.3389/fpubh.2022.1029190

Cited by 52 publications

(22 citation statements)

References 41 publications

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“…Furthermore, males were over-represented in the most critical TGs (TG3/TG4), in line with sex as a risk factor of COVID-19 severity. 23,24 Additionally, our results support Hispanic ethnicity correlating with severity. 25,26 Notably, Hispanics formed a higher percentage of TG3, with higher rates of obesity and cardiovascular/renal comorbidities.…”

Section: Discussionsupporting

confidence: 73%

Dissecting Clinical Features of COVID-19 in a Cohort of 21,312 Acute Care Patients

Maguire,

Soloveichik,

Blinchevsky

et al. 2023

Preprint

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COVID-19 has resulted in over 645 million hospitalization and 7 million deaths globally. However, many questions still remain about clinical complications in COVID-19 and if these complications changed with different circulating SARS-CoV-2 strains.We analyzed a 2.5-year retrospective cohort of 47,063 encounters for 21,312 acute care patients at five Central Texas hospitals and define distinct trajectory groups (TGs) with latent class mixed modeling, based on the World Health Organization COVID-19 Ordinal Scale. Using this TG framework, we evaluated the association of demographics, diagnoses, vitals, labs, imaging, consultations, and medications with COVID-19 severity and broad clinical outcomes.Patients within 6 distinct TGs differed in manifestations of multi-organ disease and multiple clinical factors. The proportion of mild patients increased over time, particularly during Omicron waves. Age separated mild and fatal patients, though did not distinguish patients with severe versus critical disease. Male and Hispanic/Latino demographics were associated with more severe/critical TGs. More severe patients had a higher rate of neuropsychiatric diagnoses, consultations, and brain imaging, which did not change significantly in severe patients across SARS-CoV-2 variant waves. More severely affected patients also demonstrated an immunological signature of high neutrophils and immature granulocytes, and low lymphocytes and monocytes. Interestingly, low albumin was one of the best lab predictors of COVID-19 severity in association with higher malnutrition in severe/critical patients, raising concern of nutritional insufficiency influencing COVID-19 outcomes. Despite this, only a small fraction of severe/critical patients had nutritional labs checked (pre-albumin, thiamine, Vitamin D, B vitamins) or received targeted interventions to address nutritional deficiencies such as vitamin replacement.Our findings underscore the significant link between COVID-19 severity, neuropsychiatric complications, and nutritional insufficiency as key risk factors of COVID-19 outcomes and raise the question of the need for more widespread early assessment of patients’ neurological, psychiatric, and nutritional status in acute care settings to help identify those at risk of severe disease outcomes.

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Section: Discussionsupporting

confidence: 73%

Dissecting Clinical Features of COVID-19 in a Cohort of 21,312 Acute Care Patients

Maguire,

Soloveichik,

Blinchevsky

et al. 2023

Preprint

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“…We also found that female sex was significantly associated with having an asthma exacerbation in the setting of SARS‐CoV‐2 infection. Though male sex has been associated with increased risk of COVID‐19 morbidity and mortality 33–36 and female sex has been associated with increased risk of long‐COVID symptoms, 37 to our knowledge female sex has not been previously associated with higher risk of COVID‐19‐related asthma exacerbations or acute asthma symptoms. These associations with SARS‐CoV‐2‐related asthma exacerbations should be further investigated in larger, multicenter studies.…”

Section: Discussionmentioning

confidence: 79%

Odds of COVID‐19‐associated asthma exacerbations in children higher during Omicron wave

Gaietto,

Bergum,

Rosser

et al. 2023

Pediatric Pulmonology

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BackgroundWe aimed to determine the association of COVID‐19 variant wave with asthma exacerbations in children with asthma.MethodsWe conducted a retrospective cross‐sectional study of children in the Western Pennsylvania COVID‐19 Registry (WPACR). We extracted data for all children in the WPACR with asthma and compared their acute clinical presentation and outcomes during the Pre‐Delta (7/1/20–6/30/21), Delta (8/1/21–12/14/21), and Omicron (12/15/21–8/30/22) waves. We conducted multivariable logistic regression analyses of SARS‐CoV‐2‐associated asthma exacerbations, adjusting for characteristics that have been associated with COVID‐19 outcomes in prior studies.ResultsAmong 573 children with asthma in the WPACR during the study period, the proportion of children with COVID‐19 who had an asthma exacerbation was higher during the Omicron wave than during the prior two variant waves (40.2% vs. 22.6% vs. 26.2%, p = 0.002; unadjusted OR = 2.12 [95% confidence interval (CI) = 1.39–3.22], p < 0.001). In our multivariable regression models, the odds of an asthma exacerbation were 2.8 times higher during the Omicron wave than during prior waves (adjusted OR = 2.80 [95% CI = 1.70–4.61]). Results were similar after additionally adjusting for asthma severity but were no longer significant after additionally adjusting for poor asthma control.ConclusionThe proportion of children with asthma experiencing an asthma exacerbation during SARS‐CoV‐2 infection was higher during Omicron than prior variant waves, adding to the body of evidence that COVID‐19‐associated respiratory symptoms vary by variant. These findings provide additional support for vaccination and prevention.

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“…While autoimmune disorders are more common among women, men might be more sensitive to hyperinflammatory conditions and might be in higher risk of developing more severe disease. For instance, men have a higher risk of developing severe COVID-19 disease and higher mortality rates [19, 20]. Furthermore, one major form of estrogen, estradiol, has been shown to dampen excessive production of innate inflammatory cytokines produced by macrophages and monocytes [19].…”

Section: Discussionmentioning

confidence: 99%

Cytokine release syndrome after treatment with immune checkpoint inhibitors: an observational cohort study of 2672 patients from Karolinska University Hospital in Sweden

Hamida,

Karlsson,

Lundqvist

et al. 2024

Preprint

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Immune checkpoint inhibitors (ICIs) are linked to diverse immune-related adverse events (irAEs). Rare irAEs surface first in clinical practice. Here, we systematically studied the rare irAE, cytokine-release syndrome (CRS), in a cohort of 2672 patients treated with ICIs at Karolinska University Hospital in Stockholm, Sweden. We find that the risk of ICI-induced CRS, defined as fever, negative microbiological findings and absence of other probable causes within 30 days after ICI treatment, is approximately 1%, higher than previously reported. ICI-induced CRS was often mild and ICI rechallenge was generally safe. Two out of 28 patients experienced high-grade CRS, and one was fatal. While C-reactive protein and procalcitonin were not discriminative of fatal CRS, our data suggest that the quick Sequential Organ Failure Assessment (qSOFA) score might identify high-risk patients. These data provide a framework for CRS risk assessment and motivate multicenter studies to improve early CRS diagnosis.

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Sex-differences in COVID-19 diagnosis, risk factors and disease comorbidities: A large US-based cohort study

Cited by 52 publications

References 41 publications

Dissecting Clinical Features of COVID-19 in a Cohort of 21,312 Acute Care Patients

Dissecting Clinical Features of COVID-19 in a Cohort of 21,312 Acute Care Patients

Odds of COVID‐19‐associated asthma exacerbations in children higher during Omicron wave

Cytokine release syndrome after treatment with immune checkpoint inhibitors: an observational cohort study of 2672 patients from Karolinska University Hospital in Sweden

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