Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Swiss Med Wkly. 2022 May 20;152:w30167. doi: 10.4414/smw.2022.w30167. eCollection 2022 May 9.
In the global COVID-19 pandemic, female sex is associated with comparable infection rates but better outcome. However, most studies lacked appropriate controls. We investigated whether these sex disparity findings are specific to patients with COVID-19 or generalizable to patients presenting to the emergency room (ER) with similar symptoms but no COVID-19.
In this prospective cohort study, consecutive patients presenting with symptoms suggestive of COVID-19 were recruited at the ER of the University Hospital Basel, Switzerland from March to June 2020. Patients were categorized as SARS-CoV-2 positive (cases) or negative (controls) based on nasopharyngeal PCR swab tests. The final clinical diagnosis was determined for all patients. The primary outcome was a composite of intensive care admission, rehospitalization for respiratory distress and all-cause death within 30 days. We used Kaplan-Meier curves and Cox proportional hazards models to explore associations between sex and outcomes.
Among 1,081 consecutive ER patients, 191 (18%) tested positive for SARS-CoV-2, with an even sex distribution (17.9% female vs. 17.5% male, p = 0.855). In COVID-19 patients, female sex was associated with lower risk of hospitalization (51% vs. 66%, p = 0.034), lower necessity of haemodynamic support (8% vs. 20%, p = 0.029), lower rates of intubation (10% vs. 21%, p = 0.037) and the primary outcome (18% vs. 31%, p = 0.045; age-adjusted HR 0.536, 95%CI 0.290-0.989, p = 0.046) compared with male sex. Sex disparities were most prominent in patients ≥55 years (HR for composite primary outcome in women 0.415, 95%CI 0.201-0.855, p = 0.017). In contrast to the COVID-19 patients, no sex-specific differences in outcomes were observed in the unselected overall control group (age-adjusted HR 0.844, 95%CI 0.560-1.273, p = 0.419) or in a subgroup of controls with upper respiratory tract infections or pneumonia (age-adjusted HR 0.840, 95%CI 0.418-1.688, p = 0.624).
In this unselected, consecutive cohort study at a tertiary hospital in Switzerland, female sex is associated with better outcome in patients presenting to the ER with COVID-19. These sex disparities seem to be at least partly specific to COVID-19, as they were not observed in comparable controls.
在全球 COVID-19 大流行中，女性的感染率相当，但结局更好。然而，大多数研究缺乏适当的对照。我们研究了这些性别差异的发现是否仅适用于 COVID-19 患者，或者是否可推广到因类似症状但无 COVID-19 而就诊于急诊室（ER）的患者。
这是一项前瞻性队列研究，在瑞士巴塞尔大学医院的 ER 连续招募了有 COVID-19 症状的患者。根据鼻咽 PCR 拭子检测，将患者分为 SARS-CoV-2 阳性（病例）或阴性（对照）。对所有患者进行最终临床诊断。主要结局是 30 天内入住 ICU、因呼吸窘迫再次住院和全因死亡的复合结局。我们使用 Kaplan-Meier 曲线和 Cox 比例风险模型来探索性别与结局之间的关系。
在 1081 例连续的 ER 患者中，191 例（18%） SARS-CoV-2 检测呈阳性，性别分布均匀（女性 17.9%，男性 17.5%，p=0.855）。在 COVID-19 患者中，女性的住院风险较低（51%比 66%，p=0.034），需要血流动力学支持的可能性较低（8%比 20%，p=0.029），气管插管的发生率较低（10%比 21%，p=0.037），主要结局（18%比 31%，p=0.045；年龄调整的 HR 0.536，95%CI 0.290-0.989，p=0.046）也较低。与男性相比，≥55 岁的患者中性别差异最为显著（女性复合主要结局的 HR 0.415，95%CI 0.201-0.855，p=0.017）。与 COVID-19 患者不同，在未选择的整体对照组（年龄调整的 HR 0.844，95%CI 0.560-1.273，p=0.419）或上呼吸道感染或肺炎的对照组亚组中（年龄调整的 HR 0.840，95%CI 0.418-1.688，p=0.624），未观察到结局的性别差异。
在瑞士一家三级医院的这项未选择的连续队列研究中，女性在因 COVID-19 就诊于 ER 的患者中结局更好。这些性别差异似乎至少部分是 COVID-19 特有的，因为在可比的对照组中未观察到这些差异。
