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Original Research

Open Access Special Issue

Sex differences in hospitalized COVID-19 patients

  • Rosaria Sofia1
  • Martina Baiardo Redaelli1
  • Olivia Belloni1
  • Perla Cicero1
  • Giovanni Landoni1,2,*,
  • Alberto Zangrillo1,2

1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy

2Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy

DOI: 10.22514/sv.2022.011 Vol.18,Issue 6,November 2022 pp.39-44

Submitted: 13 October 2021 Accepted: 07 December 2021

Published: 08 November 2022

*Corresponding Author(s): Giovanni Landoni E-mail: landoni.giovanni@hsr.it

Abstract

The novel coronavirus disease (COVID-19) affected females less than males, as demonstrated by sex-disaggregated data present in the literature. During the first wave, females hospitalized at San Raffaele Hospital, Milan, Italy were few in number, presented symptoms later and had less critical clinical conditions than males. The present study aimed to evaluate the epidemiological status of the female population during the second wave, which occurred in Autumn 2020 in Italy. This prospective cohort study included all patients, with a positive real-time reverse-transcriptase polymerase chain reaction for COVID-19, who attended the emergency department or were hospitalized in wards and/or intensive care unit (ICU) from 29th September 2020 to 29th November 2020. A total of 1216 COVID-19 patients were included, of whom 459 (37.8%) were females. The percentage of females admitted was 41.3% in the first period and 36.3% in the second period, without significant increase over time (p = 0.3). Females accounted for 25% of all COVID-19 intensive care unit admissions. There was significantly sex-based difference in the overall hospital mortality (4.1% for females and 11.3% for males, p < 0.0001). At San Raffaele Hospital, Milan, Italy during the second wave, female patients were few and affected by a less severe form of COVID-19. An increase over time of females hospitalized patients was not reported, unlike what was previously demonstrated during the first wave.


Keywords

COVID-19; Sex-disaggregated data; Sex; Intensive care unit; Critical care; Patient outcome; Italy


Cite and Share

Rosaria Sofia,Martina Baiardo Redaelli,Olivia Belloni,Perla Cicero,Giovanni Landoni,Alberto Zangrillo. Sex differences in hospitalized COVID-19 patients. Signa Vitae. 2022. 18(6);39-44.

References

[1] Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579: 270–273.

[2] World Health Organization . Coronavirus disease 2019 ( COVID-19) : situation report, 51. 2020. Available at: https://apps.who.int/iris/handle/10665/331475 (Accessed: 17 April 2021).

[3] Pérez-López FR, Tajada M, Savirón-Cornudella R, Sánchez-Prieto M, Chedraui P, Terán E. Coronavirus disease 2019 and gender-related mortality in European countries: a meta-analysis. Maturitas. 2020; 141: 59–62.

[4] Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Frontiers in Public Health. 2020; 8: 152.

[5] Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biology of Sex Differences. 2020; 11: 29.

[6] Ortolan A, Lorenzin M, Felicetti M, Doria A, Ramonda R. Does gender influence clinical expression and disease outcomes in COVID-19? a systematic review and meta-analysis. International Journal of Infectious Diseases. 2020; 99: 496–504.

[7] Global Health 50/50. The Sex, gender and Covid-19 Project. 2021. Available at: https://globalhealth5050.org/the-sex-gender-and-covid-19-project/ (Accessed: 22 April 2021).

[8] Baiardo Redaelli M, Landoni G, Di Napoli D, Morselli F, Sartorelli M, Sartini C, et al. Novel Coronavirus Disease (COVID-19) in Italian patients: gender differences in presentation and severity. Saudi Journal of Medicine and Medical Sciences. 2021; 9: 59–62.

[9] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Van-denbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370: 1453–1457.

[10] EpiCentro. Sorveglianza Integrata COVID-19 in Italia [Internet]. 2020. Available at: https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_2-dicembre-2020.pdf (Accessed: 2 December 2020).

[11] Chiarella SE, Pabelick C, Prakash YS. Sex differences in the Coronavirus Disease 2019. Physiology in Health and Disease. 2021; 7: 471–490.

[12] Karlberg J, Chong DSY, Lai WYY. Do men have a higher case fatality rate of severe acute respiratory syndrome than women do? American Journal of Epidemiology. 2004; 159: 229–231.

[13] Alghamdi IG, Hussain II, Almalki SS, Alghamdi MS, Alghamdi MM, El-Sheemy MA. The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health. International Journal of General Medicine. 2014; 7: 417–423.

[14] Li L, Huang T, Wang YQ, Wang ZP, Liang Y, Huang T, et al. COVID‐19 patients’ clinical characteristics, discharge rate, and fatality rate of meta‐analysis. Journal of Medical Virology. 2020; 92: 577–583.

[15] Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020; 323: 1574–1581.

[16] Klein SL, Dhakal S, Ursin RL, Deshpande S, Sandberg K, Mauvais-Jarvis F. Biological sex impacts COVID-19 outcomes. PLOS Pathogens. 2020; 16: e1008570.

[17] Sharma G, Volgman AS, Michos ED. Sex differences in mortality from COVID-19 Pandemic. JACC: Case Reports. 2020; 2: 1407–1410.

[18] Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323: 1239–1242.

[19] Straub RH. The complex role of estrogens in inflammation. Endocrine Reviews. 2007; 28: 521–574.

[20] Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses. Cell Death & Differentiation. 2020; 27: 1451–1454.

[21] Takahashi T, Ellingson MK, Wong P, Israelow B, Lucas C, Klein J, et al. Sex differences in immune responses that underlie COVID-19 disease outcomes. Nature. 2020; 588: 315–320.

[22] Lokugamage KG, Hage A, de Vries M, Valero-Jimenez AM, Schindewolf C, Dittmann M, et al. Type I interferon susceptibility distinguishes SARS-CoV-2 from SARS-CoV. Journal of Virology. 2020; 94: e01410–20.

[23] Blanco-Melo D, Nilsson-Payant BE, Liu WC, Uhl S, Hoagland D, Møller R, et al. Imbalanced host response to SARS-CoV-2 drives development of COVID-19. Cell. 2020; 181: 1036–1045.

[24] Hadjadj J, Yatim N, Barnabei L, Corneau A, Boussier J, Smith N, et al. Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients. Science. 2020; 369: 718–724.

[25] Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovascular Research. 2020; 116: 2197–2206.

[26] Grifoni E, Valoriani A, Cei F, Lamanna R, Gelli AMG, Ciambotti B, et al. Interleukin-6 as prognosticator in patients with COVID-19. Journal of Infection. 2020; 81: 452–482.

[27] Conti P, Younes A. Coronavirus COV-19/SARS-CoV-2 affects women less than men: clinical response to viral infection. Journal of Biological Regulators & Homeostatic Agents. 2020; 34: 339–343.

[28] Wehbe Z, Hammoud SH, Yassine HM, Fardoun M, El-Yazbi AF, Eid AH. Molecular and biological mechanisms underlying gender differences in COVID-19 severity and mortality. Frontiers in Immunology. 2021; 12: 659339.

[29] Giefing-Kröll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell. 2015; 14: 309–321.

[30] Li Y, Zhou W, Yang L, You R. Physiological and pathological regulation of ACE2, the SARS-CoV-2 receptor. Pharmacological Research. 2020; 157: 104833.

[31] Swärd P, Edsfeldt A, Reepalu A, Jehpsson L, Rosengren BE, Karlsson MK. Age and sex differences in soluble ACE2 may give insights for COVID-19. Critical Care. 2020; 24: 221.

[32] Jia H. Pulmonary Angiotensin-converting enzyme 2 (ACE2) and inflammatory lung disease. Shock. 2016; 46: 239–248.

[33] Biswas DK, Singh S, Shi Q, Pardee AB, Iglehart JD. Crossroads of estrogen receptor and NF-kappaB signaling. Science’s STKE: Signal Transduction Knowledge Environment. 2005; 2005: pe27.

[34] Pontecorvi G, Bellenghi M, Ortona E, Carè A. MicroRNAs as new possible actors in gender disparities of Covid‐19 pandemic. Acta Physiologica. 2020; 230: e13538.


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