Sex-based clinical and immunological differences in COVID-19

BMC Infectious Diseases

Lingxiang Wu¹  Min Wu¹  Yun Cai¹  Ning Li¹  Kening Li¹  Mengyan Zhu¹  Lu Li¹  Wei Wu¹  Wanlin Li¹  Jie Li¹  Ziyu Wang¹  Bin Huang²  Lishen Zhang²  Qianghu Wang³  Zhihua Wang⁴  Shukui Wang⁵  Xinyi Xia⁶  Hongshan Chen⁷ 

[1] Center for Global Health, School of Public Health, Nanjing Medical University, 211166, Nanjing, Jiangsu, China;Department of Bioinformatics, Nanjing Medical University, 211166, Nanjing, Jiangsu, China;Center for Global Health, School of Public Health, Nanjing Medical University, 211166, Nanjing, Jiangsu, China;Department of Bioinformatics, Nanjing Medical University, 211166, Nanjing, Jiangsu, China;Key Laboratory of Cardiovascular & Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China;Center for Global Health, School of Public Health, Nanjing Medical University, 211166, Nanjing, Jiangsu, China;Department of Bioinformatics, Nanjing Medical University, 211166, Nanjing, Jiangsu, China;State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 211166, Nanjing, China;Department of Laboratory Medicine & Blood Transfusion, the 907th Hospital, 350702, Nanping, Fujian, China;Joint Expert Group for COVID-19, Department of Laboratory Medicine & Blood Transfusion, Wuhan Huoshenshan Hospital, 430100, Wuhan, China;Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, Jiangsu, China;Joint Expert Group for COVID-19, Department of Laboratory Medicine & Blood Transfusion, Wuhan Huoshenshan Hospital, 430100, Wuhan, China;COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing Clinical College of Southern Medical University, 210002, Nanjing, Jiangsu, China;Key Laboratory of Cardiovascular & Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China;Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China;Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China;

关键词: COVID-19;    Sex;    Immunology;    Prognosis;    SARS-CoV-2;   

DOI  :  10.1186/s12879-021-06313-2

来源: Springer

【 摘 要 】

BackgroundMales 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.MethodsWe 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.ResultsWe 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 [HR] = 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.ConclusionsMales 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.

【 授权许可】

CC BY