1. Better prognosis in females with severe COVID-19 pneumonia: possible role of inflammation as potential mediator
- Author
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Cristina Mussini, Alessandro Cozzi-Lepri, Marianna Menozzi, Marianna Meschiari, Erica Franceschini, Carlotta Rogati, Gianluca Cuomo, Andrea Bedini, Vittorio Iadisernia, Sara Volpi, Jovana Milic, Roberto Tonelli, Lucio Brugioni, Antonello Pietrangelo, Massimo Girardis, Andrea Cossarizza, Enrico Clini, Giovanni Guaraldi, Erica Bacca, Vanni Borghi, Giulia Burastero, Federica Carli, Giacomo Ciusa, Luca Corradi, Margherita Di Gaetano, Matteo Faltoni, Giacomo Franceschi, Gabriella Orlando, Francesco Pellegrino, Cinzia Puzzolante, Alessandro Raimondi, Antonella Santoro, Marco Tutone, Dina Yaacoub, Alberto Andreotti, Emanuela Biagioni, Filippo Bondi, Stefano Busani, Giovanni Chierego, Marzia Scotti, Lucia Serio, Caterina Bellinazzi, Rebecca Borella, Sara De Biasi, Anna De Gaetano, Lucia Fidanza, Lara Gibellini, Anna Iannone, Domenico Lo Tartaro, Marco Mattioli, Annamaria Paolini, Rossella Fogliani, Grazia Righini, and Mario Lugli
- Subjects
Male ,sex differences ,0301 basic medicine ,Microbiology (medical) ,Mediation (statistics) ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Context (language use) ,Pathogenesis ,Cohort Studies ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Respiratory system ,female sex ,Survival analysis ,Aged ,Retrospective Studies ,Inflammation ,Mechanical ventilation ,SARS-CoV-2 ,business.industry ,Absolute risk reduction ,COVID-19 ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Respiration, Artificial ,Hospitalization ,Pneumonia ,Infectious Diseases ,SARS-CoV-2, COVID-19, female sex, prognosis, inflammation ,inflammation ,Commentary ,Female ,prognosis ,CRP ,business ,Cohort study - Abstract
Objectives Sex differences in COVID-19 severity and mortality have been described. Key aims of this analysis were to compare the risk of invasive mechanical ventilation (IMV) and mortality by sex and to explore whether variation in specific biomarkers could mediate this difference. Methods This was a retrospective, observational cohort study among patients with severe COVID-19 pneumonia. A survival analysis was conducted to compare time to the composite endpoint of IMV or death by sex. Interaction was formally tested to compare the risk difference by sex in subsets. Mediation analysis with a binary endpoint IMV or death (yes/no) by end of follow-up for a number of inflammation/coagulation biomarkers in the context of counterfactual prediction was also conducted. Results Among 415 patients, 134 were females (32%) and 281 males (67%), median age 66 years (IQR 54-77). At admission, females showed a significantly less severe clinical and respiratory profiles with a higher PaO2/FiO2 (254 mmHg vs 191 mmHg; p=0.023). By 28 days from admission, 49.2% (95% CI: 39.6-58.9%) of males vs. 31.7% (17.9-45.4%) of females underwent IMV or death (log-rank p-value Conclusions Our analysis confirms a difference in the risk of COVID-19 clinical progression by sex and provides a hypothesis for potential mechanisms leading to this. CRP showed a predominant role to mediate the difference in risk by sex.
- Published
- 2021
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