Abstract
The high mortality observed in Covid-19 patients may be related to unrecognized pulmonary embolism, pulmonary thrombosis, or other underlying cardiovascular diseases. Recent data have highlighted that the mortality rate of Covid-19 seems to be higher in male patients compared to females. In this paper, we have analyzed possible factors that may underline this sex difference in terms of activity of the immune system and its modulation by sex hormones, coagulation pattern, and preexisting cardiovascular diseases as well as effects deriving from smoking and drinking habits. Future studies are needed to evaluate the effects of sex differences on the prevalence of infections, including Covid-19, its outcome, and the responses to antiviral treatments.
Highlights
All countries around the world are facing the COVID-19 emergency
Considering that sex differences are frequently observed in many diseases, responses to drugs and the occurrence of adverse drugs reactions [14,15,16,17]—and that many reasons may underline these differences—in this paper, we aim to provide an overview of factors, including those influencing the immune system response, that possibly underline the sex and gender differences observed in Covid-19 patients
Even though the angiotensin-converting enzyme 2 (ACE2) plays an essential role in the renin-angiotensin system (RAS) system, it should be highlighted that a recent retrospective cohort study, carried out on 4,480 patients with Covid-19, showed that the prior use of ACE inhibitors or angiotensin receptor blockers was not significantly associated with COVID-19 diagnosis neither with mortality or severe disease [53]
Summary
All countries around the world are facing the COVID-19 emergency. As of June 22nd, more than 9,118,000 people have contracted the disease, and deaths have exceeded 471,0001. About 20% of patients with COVID-19 progress to a third stage, which is the most severe, and this stage is characterized by serious respiratory symptoms that include hypoxia, ground glass infiltrate, and progression to acute respiratory distress syndrome (ARDS) This stage can be further aggravated by organ failure and sepsis, potentially progressing to patient’s death [6]. Considering that sex differences are frequently observed in many diseases, responses to drugs and the occurrence of adverse drugs reactions [14,15,16,17]—and that many reasons may underline these differences—in this paper, we aim to provide an overview of factors, including those influencing the immune system response, that possibly underline the sex and gender differences observed in Covid-19 patients.
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