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Sex-based clinical and immunological differences in COVID-19
Bin Huang1,2,3, Yun Cai1,2, Ning Li1,2
1Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.
BMC Infectious Diseases
|July 6, 2021
Summary
Male COVID-19 patients experienced worse outcomes, including higher ICU admission and mortality rates, compared to females. This study highlights sex-based differences in immune response and suggests tailored medical interventions for males.
Area of Science:
- Immunology
- Infectious Diseases
- Sex Differences in Health
Background:
- Biological sex significantly influences immunological responses to pathogens.
- Current COVID-19 clinical practices often overlook sex-based disparities in disease outcomes and immune reactions.
Purpose of the Study:
- To conduct a sex-based comparative analysis of clinical outcomes, immune cell profiles, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels in COVID-19 patients.
- To identify sex-specific risk factors and immune responses associated with COVID-19 severity and prognosis.
Main Methods:
- Comparative analysis of 1558 males and 1499 females with COVID-19.
- Flow cytometry for lymphocyte subgroup analysis.
- Chemiluminescence assays for measuring SARS-CoV-2 specific IgM and IgG antibody levels (S, RBD, N proteins).
Main Results:
- Male patients exhibited approximately double the rates of ICU admission and mortality compared to females.
- Male sex was identified as an independent risk factor for COVID-19 mortality.
- Males showed higher levels of inflammatory cytokines, increased renal and hepatic abnormalities, and a delayed antibody response (RBD-specific IgG peaked at 7 weeks vs. 4 weeks in females).
- Females generally maintained higher percentages of CD19+ B cells and CD4+ T cells during infection.
Conclusions:
- Males face a more unfavorable prognosis in COVID-19, characterized by heightened inflammation, reduced lymphocyte percentages, and slower antibody development.
- Sex-specific differences in immune response and clinical outcomes necessitate consideration in COVID-19 management.
- Early medical intervention and close monitoring are crucial for male COVID-19 patients due to their increased risk profile.
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