Abstract
Male novel coronavirus disease (COVID-19) patients tend to have poorer clinical outcomes than female patients, while the myocardial injury is strongly associated with COVID-19-related adverse events. Owing to a lack of corresponding data, we aimed to investigate the sex differences in the incidence of myocardial injury in COVID-19 patients and to identify the potential underlying mechanisms, which may partly account for the sex bias in the incidence of adverse events. This retrospective study included 1,157 COVID-19 patients who were hospitalized in Huoshenshan Hospital from 12 March 2020 to 11 April 2020. Data on the patients’ demographic characteristics, initial symptoms, comorbidities and laboratory tests were collected. Totally, 571 (49.4%) female and 586 (50.6%) male COVID-19 patients were enrolled. The incidence of myocardial injury was higher among men than women (9.2 vs. 4.9%, p = 0.004). In the logistic regression analysis, age, and chronic kidney disease were associated with myocardial injury in both sexes. However, hypertension [odds ratio (OR) = 2.25, 95% confidence interval (CI) 1.20–4.22], coronary artery disease (OR = 2.46, 95% CI 1.14–5.34), leucocyte counts (OR = 3.13, 95% CI 1.24–7.86), hs-CRP (OR = 4.45, 95% CI 1.33–14.83), and D-dimer [OR = 3.93 (1.27–12.19), 95% CI 1.27–12.19] were independent risk factors only in the men. The correlations of hs-CRP and D-dimer with hs-cTnI and BNP were stronger in the men. The incidence of myocardial injury in COVID-19 patients is sex-dependent, predominantly in association with a greater degree of inflammation and coagulation disorders in men. Our findings can be used to improve the quality of clinical management in such settings.
Highlights
As of November 2020, the novel 2019 coronavirus disease (COVID-19) has led to more than 55 million confirmed cases worldwide, including nearly 1.5 million deaths (World Health Organization, 2020b)
After the exclusion of two patients aged under 18 years, 27 without laboratory test data and 15 without high-sensitivity cardiac troponin I (hs-cTnI) test data, 1,157 patients were included in our final analysis, comprising 571 (49.4%) women and 586 (50.6%) men
Among the 1,157 COVID-19 patients included in our study, a significantly higher incidence of myocardial injury was observed in men than women (9.2 vs. 4.9%, p = 0.004) (Figure 1B)
Summary
As of November 2020, the novel 2019 coronavirus disease (COVID-19) has led to more than 55 million confirmed cases worldwide, including nearly 1.5 million deaths (World Health Organization, 2020b). Sex Differences of Myocardial Injury clinical characteristics of COVID-19 have shown that, in addition to old age and comorbidities, sex differences are associated with disease deterioration and mortality (Chen et al, 2020; Yang et al, 2020), with male patients showing significantly higher mortality values (Epidemiology Working Group for NCIP Epidemic Response, 2020). In Spain, the mortality among male COVID-19 patients is twice as high as that among their female counterparts (Pastor-Barriuso et al, 2020). While some studies showed that the incidence of myocardial injury is higher among men than women (Guo et al, 2020), others did not observe significant sex-related differences (Shi et al, 2020b). Whether the incidence of COVID-19-related myocardial injury is sex-dependent remains controversial
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