tetano
Editor, Senior Moderator
BMC Infect Dis
. 2021 Jul 5;21(1):647.
doi: 10.1186/s12879-021-06313-2.
Sex-based clinical and immunological differences in COVID-19
Bin Huang[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Yun Cai[SUP] #[/SUP][SUP] 1 2 [/SUP], Ning Li[SUP] #[/SUP][SUP] 1 2 [/SUP], Kening Li[SUP] #[/SUP][SUP] 1 2 [/SUP], Zhihua Wang[SUP] 4 5 [/SUP], Lu Li[SUP] 1 2 [/SUP], Lingxiang Wu[SUP] 1 2 [/SUP], Mengyan Zhu[SUP] 1 2 [/SUP], Jie Li[SUP] 1 2 [/SUP], Ziyu Wang[SUP] 1 2 [/SUP], Min Wu[SUP] 1 2 [/SUP], Wanlin Li[SUP] 1 2 [/SUP], Wei Wu[SUP] 1 2 [/SUP], Lishen Zhang[SUP] 1 2 3 [/SUP], Xinyi Xia[SUP] 6 7 [/SUP], Shukui Wang[SUP] 8 [/SUP], Hongshan Chen[SUP] 9 10 11 [/SUP], Qianghu Wang[SUP] 12 13 14 [/SUP]
Affiliations
Abstract
Background: Males and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take the sex factor into consideration.
Methods: We performed a sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels of 1558 males and 1499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. The total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence.
Results: We found that male patients had approximately two-fold rates of ICU admission (4.7% vs. 2.7% in males and females, respectively, P = 0.005) and mortality (3% vs. 1.4%, in males and females, respectively, P = 0.004) than female patients. Survival analysis revealed that the male sex is an independent risk factor for death from COVID-19 (adjusted hazard ratio
= 2.22, 95% confidence interval [CI]: 1.3-3.6, P = 0.003). The level of inflammatory cytokines in peripheral blood was higher in males during hospitalization. The renal (102/1588 [6.5%] vs. 63/1499 [4.2%], in males and females, respectively, P = 0.002) and hepatic abnormality (650/1588 [40.9%] vs. 475/1499 [31.7%], P = 0.003) were more common in male patients than in female patients. By analyzing dynamic changes of lymphocyte subsets after symptom onset, we found that the percentage of CD19+ B cells and CD4+ T cells was generally higher in female patients during the disease course of COVID-19. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in female patients, while gradually increased and reached a peak in the seventh week after symptom onset in male patients.
Conclusions: Males had an unfavorable prognosis, higher inflammation, a lower percentage of lymphocytes, and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients.
Keywords: COVID-19; Immunology; Prognosis; SARS-CoV-2; Sex.
. 2021 Jul 5;21(1):647.
doi: 10.1186/s12879-021-06313-2.
Sex-based clinical and immunological differences in COVID-19
Bin Huang[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Yun Cai[SUP] #[/SUP][SUP] 1 2 [/SUP], Ning Li[SUP] #[/SUP][SUP] 1 2 [/SUP], Kening Li[SUP] #[/SUP][SUP] 1 2 [/SUP], Zhihua Wang[SUP] 4 5 [/SUP], Lu Li[SUP] 1 2 [/SUP], Lingxiang Wu[SUP] 1 2 [/SUP], Mengyan Zhu[SUP] 1 2 [/SUP], Jie Li[SUP] 1 2 [/SUP], Ziyu Wang[SUP] 1 2 [/SUP], Min Wu[SUP] 1 2 [/SUP], Wanlin Li[SUP] 1 2 [/SUP], Wei Wu[SUP] 1 2 [/SUP], Lishen Zhang[SUP] 1 2 3 [/SUP], Xinyi Xia[SUP] 6 7 [/SUP], Shukui Wang[SUP] 8 [/SUP], Hongshan Chen[SUP] 9 10 11 [/SUP], Qianghu Wang[SUP] 12 13 14 [/SUP]
Affiliations
- PMID: 34225644
- DOI: 10.1186/s12879-021-06313-2
Abstract
Background: Males and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take the sex factor into consideration.
Methods: We performed a sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels of 1558 males and 1499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. The total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence.
Results: We found that male patients had approximately two-fold rates of ICU admission (4.7% vs. 2.7% in males and females, respectively, P = 0.005) and mortality (3% vs. 1.4%, in males and females, respectively, P = 0.004) than female patients. Survival analysis revealed that the male sex is an independent risk factor for death from COVID-19 (adjusted hazard ratio
= 2.22, 95% confidence interval [CI]: 1.3-3.6, P = 0.003). The level of inflammatory cytokines in peripheral blood was higher in males during hospitalization. The renal (102/1588 [6.5%] vs. 63/1499 [4.2%], in males and females, respectively, P = 0.002) and hepatic abnormality (650/1588 [40.9%] vs. 475/1499 [31.7%], P = 0.003) were more common in male patients than in female patients. By analyzing dynamic changes of lymphocyte subsets after symptom onset, we found that the percentage of CD19+ B cells and CD4+ T cells was generally higher in female patients during the disease course of COVID-19. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in female patients, while gradually increased and reached a peak in the seventh week after symptom onset in male patients.
Conclusions: Males had an unfavorable prognosis, higher inflammation, a lower percentage of lymphocytes, and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients.
Keywords: COVID-19; Immunology; Prognosis; SARS-CoV-2; Sex.