Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.
Department of Otorhinolaryngology-Head and Neck Center, Helsinki University Hospital, Helsinki, Finland.
Infect Dis (Lond). 2022 Aug;54(8):558-571. doi: 10.1080/23744235.2022.2055786. Epub 2022 Mar 30.
Male sex predicts case-fatality in SARS-CoV-2 (COVID-19) - a phenomenon linked to systemic inflammation. We compared sex-related associations of inflammation parameters and outcome in a population-based setting with low case-fatality prior to wide use of immunosuppressives.
A population-based quality registry with laboratory-confirmed COVID-19 cases of specialized hospitals of the Capital Province of Finland were analysed to compare inflammatory parameters by sex during the first COVID-19 wave February-June 2020.
Altogether, 585 hospitalized patients (54% males) were included. Males required more often intensive care unit (ICU) treatment (26.9 17.5%) and had higher 90-d case-fatality (14.9 7.8%) compared with females. Highest association with case-fatality in males was seen for high neutrophil counts (median; interquartile range) (8.70; 7.10-9.10 5.60; 3.90-7.80) (E9/l), low monocyte (0.50; 0.20-1.50 0.70; 0.50-0.90) (E9/l) and lymphocyte (0.90; 0.70-1.40 vs. 1.50; 1.10-2.00) (E9/l) counts, and high levels of d-dimer (3.80; 1.80-5.30 . 1.10; 0.60-2.75) (mg/l) and C-reactive protein (CRP) (190; 85.5-290 77.0; 49.0-94.0) (mg/l). In females, low lymphocyte (0.95; interquartile range 0.60-1.28 1.50; 1.10-2.00) (E9/l) and thrombocyte counts (196; 132-285 325; 244-464) (E9/l) and high CRP values (95.0; 62.0-256 . 66.0; 42.5-89.0) (mg/l) were associated with case-fatality. In multivariable analysis for males, lymphocyte cut-off 0.85 (E9/l) (OR 0.02; 95% CI 0.002-0.260), d-dimer cut-off 1.15 (mg/l) (OR 7.29; 1.01-52.6) and CRP cut-off 110 (mg/l) (OR 15.4; 1.87-127) were independently associated with case-fatality. In female multivariable analysis, CRP cut-off 81 (mg/l) (OR 7.32; 1.44-37.2) was the only inflammatory parameter associated with case-fatality.
COVID-19 results in higher inflammation parameter levels in male female patients irrespective of outcome. This study suggests that low lymphocyte, high d-dimer and high CRP cut-off values may serve as potential markers for risk stratification in male patients.
男性在严重急性呼吸综合征冠状病毒 2 型（COVID-19）中的病死率较高，这一现象与全身炎症有关。在广泛使用免疫抑制剂之前，我们在一个病死率较低的人群中比较了炎症参数与性别相关的关系和结局。
分析芬兰首都地区专科医院的基于人群的 COVID-19 病例质量登记处，以比较 2020 年 2 月至 6 月第一波 COVID-19 期间男性和女性的炎症参数。
共纳入 585 例住院患者（54%为男性）。与女性相比，男性更常需要入住重症监护病房（26.9%比 17.5%），90 天病死率更高（14.9%比 7.8%）。在男性中，与病死率最高相关的是高中性粒细胞计数（中位数；四分位距）（8.70；7.10-9.10比 5.60；3.90-7.80）（E9/L）、低单核细胞（0.50；0.20-1.50比 0.70；0.50-0.90）（E9/L）和淋巴细胞（0.90；0.70-1.40比 1.50；1.10-2.00）（E9/L）计数，以及高水平的 D-二聚体（3.80；1.80-5.30比 1.10；0.60-2.75）（mg/L）和 C 反应蛋白（CRP）（190；85.5-290比 77.0；49.0-94.0）（mg/L）。在女性中，低淋巴细胞（0.95；四分位距 0.60-1.28比 1.50；1.10-2.00）（E9/L）和血小板计数（196；132-285比 325；244-464）（E9/L）以及高 CRP 值（95.0；62.0-256比 66.0；42.5-89.0）（mg/L）与病死率相关。在男性的多变量分析中，淋巴细胞截断值 0.85（E9/L）（OR 0.02；95%CI 0.002-0.260）、D-二聚体截断值 1.15（mg/L）（OR 7.29；1.01-52.6）和 CRP 截断值 110（mg/L）（OR 15.4；1.87-127）与病死率独立相关。在女性多变量分析中，CRP 截断值 81（mg/L）（OR 7.32；1.44-37.2）是唯一与病死率相关的炎症参数。
无论结局如何，COVID-19 都会导致男性和女性患者的炎症参数水平升高。本研究表明，低淋巴细胞、高 D-二聚体和高 CRP 截断值可能是男性患者风险分层的潜在标志物。
