MALE SEX AND CHRONIC KIDNEY DISEASE: A POTENT PROGNOSTIC COMBINATION IN COVID-19

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: That mortality from COVID-19 (Coronavirus Disease 2019) is higher in males is well-documented in the scientific literature. One explanation implicates the tendency for coronavirus to concentrate in the testis as a means of delaying viral clearance in males. This study aims to explore the strength of male sex as a prognosticator of COVID-19 severity and mortality in relationship to comorbidities. METHODS: All patients at a 619-bed teaching hospital in Southern California who were PCR-tested for SARS-CoV-2 between March 2020-2021 were selected for retrospective chart review. Patient characteristics of age, sex, and comorbidities of obesity, diabetes, chronic obstructive pulmonary disease, chronic kidney disease (CKD), and heart failure were recorded based on billing codes. The primary outcome was mortality, with secondary outcomes of sepsis, admission to the intensive care unit (ICU), and the use of mechanical ventilation. All statistical analyses, which included logistic regression to assess for associations between the aforementioned patient characteristics and disease outcomes, were performed with SPSS. RESULTS: A total of 1,220 patients were included for analysis. Of these, 663 were male (54.3%, 95% CI 51.5-57.1%). CKD was present in 476 patients (39.0%, 95% CI 36.3-41.8%). Mortality was significantly higher in males than females (OR 1.37, 95% CI 1.04-1.81, P = 0.03). Males were 1.41 times more likely to develop sepsis than females (OR 1.41, 95% CI 1.07-1.87, P = 0.02). Males were 1.69 times more likely to require ICU care than females (OR 1.69, 95% CI 1.32-2.16, P <0.01). Males were also nearly twice as likely to be intubated than females (OR 1.79, 95% CI 1.36-2.36, P < 0.01). When controlling for age, sex, and comorbidities, males with chronic kidney disease (CKD) were 4.56 more likely to die than females with COVID-19 and CKD (adjusted OR 4.56, 95% CI 3.22-6.46, P < 0.01). Similarly, males with CKD were over four times more likely to be admitted to the ICU (adjusted OR 4.21, 95% CI 3.14-5.63, P < 0.01). Further, males with CKD were nearly five times more likely to be intubated (adjusted OR 4.72, 95% CI 3.40-6.54, P <0.01). No other comorbidities were significantly associated with sex and COVID-19 outcomes. CONCLUSIONS: After assessing for associations between our pre-determined patient characteristics and outcome variables, the combination of male sex and CKD was the strongest predictor of mortality, ICU admission, and intubation. Male sex alone was a significant predictor of mortality, sepsis, ICU admission, and the use of mechanical ventilation. A particularly poor prognosticator for males was CKD as a comorbidity. Males with CKD were over 4 times more likely to die than females with CKD, and nearly 5 times more likely to be intubated. Because this was a retrospective study, results are subject to confounding factors. More research is needed to understand the mechanisms driving the association between males with CKD and poor COVID-19 outcomes. CLINICAL IMPLICATIONS: Our large, single-center study demonstrates a standout combination of risk factors for poor outcomes in COVID-19: male sex and CKD. Just what makes this such a lethal combination in COVID-19 is unclear, but this knowledge can inform future research into the pathophysiology of this deadly disease. DISCLOSURES: No relevant relationships by Daryl Banta, source=Web Response No relevant relationships by Michael Guajardo, source=Web Response No relevant relationships by Eva Ma, source=Web Response No relevant relationships by Adrienne Quinn, source=Web Response No relevant relationships by Alberto Russell, source=Web Response No relevant relationships by Ayman Saad, source=Web Response No relevant relationships by Rebecca Wahinehookae, source=Web Response