Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave. SL53, New Orleans, LA, 70112, USA.
Southeast Louisiana Veterans Affairs Healthcare System, New Orleans, LA 70119, USA.
Biol Sex Differ. 2021 Feb 5;12(1):20. doi: 10.1186/s13293-021-00359-2.
Determine if sex differences exist in clinical characteristics and outcomes of adults hospitalized for coronavirus disease 2019 (COVID-19) in a US healthcare system.
Case series study.
Sequentially hospitalized adults admitted for COVID-19 at two tertiary care academic hospitals in New Orleans, LA, between 27 February and 15 July 2020.
Measures included demographics, comorbidities, presenting symptoms, and laboratory results. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), and in-hospital death.
We included 776 patients (median age 60.5 years; 61.4% women, 75% non-Hispanic Black). Rates of ICU, IMV, and death were similar in both sexes. In women versus men, obesity (63.8 vs 41.6%, P < 0.0001), hypertension (77.6 vs 70.1%, P = 0.02), diabetes (38.2 vs 31.8%, P = 0.06), chronic obstructive pulmonary disease (COPD, 22.1 vs 15.1%, P = 0.015), and asthma (14.3 vs 6.9%, P = 0.001) were more prevalent. More women exhibited dyspnea (61.2 vs 53.7%, P = 0.04), fatigue (35.7 vs 28.5%, P = 0.03), and digestive symptoms (39.3 vs 32.8%, P = 0.06) than men. Obesity was associated with IMV at a lower BMI (> 35) in women, but the magnitude of the effect of morbid obesity (BMI ≥ 40) was similar in both sexes. COPD was associated with ICU (adjusted OR (aOR), 2.6; 95%CI, 1.5-4.3) and IMV (aOR, 1.8; 95%CI, 1.2-3.1) in women only. Diabetes (aOR, 2.6; 95%CI, 1.2-2.9), chronic kidney disease (aOR, 2.2; 95%CI, 1.3-5.2), elevated neutrophil-to-lymphocyte ratio (aOR, 2.5; 95%CI, 1.4-4.3), and elevated ferritin (aOR, 3.6; 95%CI, 1.7-7.3) were independent predictors of death in women only. In contrast, elevated D-dimer was an independent predictor of ICU (aOR, 7.3; 95%CI, 2.7-19.5), IMV (aOR, 6.5; 95%CI, 2.1-20.4), and death (aOR, 4.5; 95%CI, 1.2-16.4) in men only.
This study highlights sex disparities in clinical determinants of severe outcomes in COVID-19 patients that may inform management and prevention strategies to ensure gender equity.
在美国医疗体系中，确定因 2019 年冠状病毒病（COVID-19）住院的成年人的临床特征和结局是否存在性别差异。
病例系列研究。
在新奥尔良的两家三级保健学术医院，于 2020 年 2 月 27 日至 7 月 15 日期间连续收治的因 COVID-19 住院的成年患者。
措施包括人口统计学特征、合并症、临床表现和实验室结果。结局包括入住重症监护病房（ICU）、接受有创机械通气（IMV）和院内死亡。
我们纳入了 776 名患者（中位年龄 60.5 岁；61.4%为女性，75%为非西班牙裔黑人）。两性的 ICU、IMV 和死亡率相似。与男性相比，女性更常见肥胖症（63.8%比 41.6%，P<0.0001）、高血压（77.6%比 70.1%，P=0.02）、糖尿病（38.2%比 31.8%，P=0.06）、慢性阻塞性肺疾病（COPD，22.1%比 15.1%，P=0.015）和哮喘（14.3%比 6.9%，P=0.001）。与男性相比，更多女性表现出呼吸困难（61.2%比 53.7%，P=0.04）、疲劳（35.7%比 28.5%，P=0.03）和消化系统症状（39.3%比 32.8%，P=0.06）。在女性中，BMI>35 的肥胖症与 IMV 相关，但病态肥胖症（BMI≥40）的影响程度在两性中相似。COPD 仅与女性 ICU（调整后的比值比（aOR），2.6；95%CI，1.5-4.3）和 IMV（aOR，1.8；95%CI，1.2-3.1）相关。糖尿病（aOR，2.6；95%CI，1.2-2.9）、慢性肾脏病（aOR，2.2；95%CI，1.3-5.2）、中性粒细胞与淋巴细胞比值升高（aOR，2.5；95%CI，1.4-4.3）和铁蛋白升高（aOR，3.6；95%CI，1.7-7.3）是女性死亡的独立预测因素。相比之下，升高的 D-二聚体是 ICU（aOR，7.3；95%CI，2.7-19.5）、IMV（aOR，6.5；95%CI，2.1-20.4）和死亡（aOR，4.5；95%CI，1.2-16.4）的独立预测因素，仅在男性中出现。
这项研究强调了 COVID-19 患者严重结局的临床决定因素中的性别差异，这可能为管理和预防策略提供信息，以确保性别平等。
