Sex-related differences in patients with coronavirus disease 2019: results of the Cardio-COVID-Italy multicentre study.
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Lombardi Carlo Mario, Specchia Claudia, Conforti Fabio, Rovere Maria Teresa La, Carubelli Valentina, Agostoni Piergiuseppe, Carugo Stefano, Danzi Gian Battista, Guazzi Marco, Mortara Andrea, Piepoli Massimo, Porto Italo, Sinagra Gianfranco, Volterrani Maurizio, Ameri Pietro, Gnecchi Massimiliano, Leonardi Sergio, Merlo Marco, Iorio Annamaria, Bellasi Antonio, Canale Claudia, Camporotondo Rita, Catagnano Francesco, Dalla Vecchia Laura Adelaide, Di Pasquale Mattia, Giovinazzo Stefano, Maccagni Gloria, Mapelli Massimo, Margonato Davide, Monzo Luca, Nuzzi Vincenzo, Oriecuia Chiara, Pala Laura, Peveri Giulia, Pozzi Andrea, Provenzale Giovanni, Sarullo Filippo, Adamo Marianna, Tomasoni Daniela, Inciardi Riccardo Maria, Senni Michele, Metra Marco
Аннотация
METHODS: This is a retrospective observational study on patients with COVID-19 infection, referred to 13 cardiology units. The primary objective was to assess the difference in risk of death between the sexes. The secondary objective was to explore sex-based heterogeneity in the association between demographic, clinical and laboratory variables, and patients' risk of death.
RESULTS: Seven hundred and one patients were included: 214 (30.5%) women and 487 (69.5%) men. During a median follow-up of 15 days, deaths occurred in 39 (18.2%) women and 126 (25.9%) men. In a multivariable Cox regression model, men had a nonsignificantly higher risk of death vs. women (P = 0.07).The risk of death was more than double in men with a low lymphocytes count as compared with men with a high lymphocytes count [overall survival hazard ratio (OS-HR) 2.56, 95% confidence interval (CI) 1.72-3.81]. In contrast, lymphocytes count was not related to death in women (P = 0.03).Platelets count was associated with better outcome in men (OS-HR for increase of 50 × 103 units: 0.88 95% CI 0.78-1.00) but not in women. The strength of association between higher PaO2/FiO2 ratio and lower risk of death was larger in women (OS-HR for increase of 50 mmHg/%: 0.72, 95% CI 0.59-0.89) vs. men (OS-HR: 0.88, 95% CI 0.80-0.98; P = 0.05).
CONCLUSIONS: Patients' sex is a relevant variable that should be taken into account when evaluating risk of death from COVID-19. There is a sex-based heterogeneity in the association between baseline variables and patients' risk of death.