Distinct Clinical Characteristics and Risk Factors for Mortality in Female COVID-19 Inpatients: A Sex-Stratified Large-Scale Cohort Study in Wuhan, China.

July 8, 2020

Chen J, Bai H, Liu J, et al.

Clinical Infectious Diseases

It is still unclear whether sex differences are associated with mortality and severity of SARS-CoV-2. We compared clinical features and outcomes between female and male inpatients with COVID-19 to determine outcome differences and risk factors. We found that more women have no initial symptoms at the onset of infection, develop fewer complications (ARDS, acute kidney injury, septic shock, cardiac injury, and coagulation disorder) and females had a lower mortality rate (5.9% vs 12.7%). We investigated the prognostic factors for females and males separately. Age, malignancy, chronic kidney disease, and days from onset to admission were risk factors for the female group, while age, hypertension, malignancy, and days from onset to admission were risk factors for males. More male patients suffered from organ damage and needed ICU admission, drug treatment, and mechanical ventilation therapy. Our results showed the serum levels of IL-2R, IL-6, and IL-8 were significantly lower in women than in men, which indicated that cytokine storms were less common in women. In the analysis of pre-existing diseases, the proportion of patients with diabetes was significantly higher in males than in females. Also a recent single cell RNA expression analysis demonstrated higher expression of ACE2 in male lungs, which may account for the high rate of severe disease and mortality in males. We found that sex was independently related to risk of mortality among hospitalized patients with COVID-19. Males faced more than twice the risk of death from COVID-19.

Chen J, Bai H, Liu J. Distinct Clinical Characteristics and Risk Factors for Mortality in Female Inpatients With Coronavirus Disease 2019 (COVID-19): A Sex-stratified, Large-scale Cohort Study in Wuhan, China. Clinical Infectious Diseases. 2020, ciaa920.

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