ARE THERE GENDER DIFFERENCES IN THE COURSE OF THE NOVEL CORONAVIRUS INFECTION?


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Abstract

Relevance: A new coronavirus infection is rapidly spreading around the world within a short time interval, causing devastating damage to the health systems of most countries. Gender is a key predisposition factor for various diseases. Some studies have drawn attention to the male dominance in overall mortality and from infection caused by the new coronavirus. Objective: to study the gender characteristics of the course of a new coronavirus infection in patients living in the Voronezh region and treated in the covid department of the Higher Educational Institution of Higher Education, Regional Clinical Hospital No. 1 from April to August 2020. Materials and methods: the material for the study were hospital records of 101 patients (men - 44/43.56℅, women - 57/56.4℅) who were treated at the base: "Voronezh Regional Clinical Hospital No. 1" in the period from April to August 2020 with a diagnosis of "New coronavirus infection COVID-19", the average age of men was 57.01±2.27, women - 57.01±2.01 years. The diagnosis was established on the basis of data from clinical, laboratory and instrumental studies. Results: in this study, age, laboratory, radiological, clinical indicators, as well as the duration of hospital treatment, taking into account concomitant pathologies, were compared and analyzed depending on gender. Conclusion: there were no significant and significant differences in the nature of the course of a new coronavirus infection (Covid-19) between men and women.

Full Text

Relevance :

A new coronavirus infection, the epicenter of which was the provincial Chinese city of Wuhan, is rapidly spreading around the world within a short time interval, causing devastating damage to the health systems of most countries.

The death of patients most often occurs as a result of the development of acute disorders in the respiratory system, while recent studies point to complications in the cardiovascular system as an aggravating factor contributing to the development of adverse outcomes, including fatal ones. [one]

Patients with Covid-19 and immunosuppressed patients often progress to a massive form of lung tissue damage, which leads to the development of such a complication as acute respiratory distress syndrome, which has adverse prognostic consequences, posing a threat to life. [2]

The main damaging effect in the pathogenesis of infection is directed to pneumocytes , immune cells and vascular endothelial cells. The course and manifestations of a new coronavirus infection are characterized by a wide range of clinical forms. [3-7]

It is noteworthy that gender is a key factor in predisposition to diseases of the cardiovascular system; it is among men that an increased prevalence and mortality is recorded. Some studies have drawn attention to the male dominance in overall mortality and from infection caused by the new coronavirus. [eight]

Purpose of the study

The study of gender characteristics of the course of a new coronavirus infection in patients treated in the covid department of the Higher Educational Institution of Higher Education, Regional Clinical Hospital No. 1 in the period from April to August 2020.

Materials and methods

The material for a retrospective study was 101 cards of inpatients (of which 44/43.6% were men, 57/56.43% were women) who were treated at the base: "Voronezh Regional Hospital No. 1" from April to August 2020 with a diagnosis of "New coronavirus infection (Covid-19)", the average age of men was 57.01±2.27, women - 57.01±2.01 years.The vast majority of hospitalized patients (76.23%) are rural residents, and 23.77% lived in the cities of the Voronezh region.

For a comparative analysis of the course of infection, the following criteria were used: the severity of the disease, the duration of hospitalization, clinical manifestations (temperature, saturation, degree of lung damage according to computed tomography, indicators of general and biochemical blood tests), comorbidities.

Statistical analysis: the sample size was not previously calculated. To analyze the results of the study, a program was used for pairwise comparison of frequencies with an exact Chi-square test , the differences in the mean values were determined by Student's t-test, the differences were considered significant at p < 0.05.

results

A comparative analysis of the condition of patients with coronavirus infection did not show significant differences between men and women. The severity of male patients was more often satisfactory (56.81%), less often of moderate severity (31.81%), in a small number of severe (9.09%) and extremely severe (2.27%). A similar situation was observed in female patients: a satisfactory condition occurred in half of the patients (52.63%), less often of moderate severity (38.59%), in a small number of severe (10.52%).

There were significant differences in relation to the severity of the condition of patients depending on age. In patients under 50 years of age, a satisfactory condition was significantly more often recorded with coronavirus infection (70.58% vs. 44.92% over 50 years old), and a moderate course was observed significantly more often in the older age group (43.47% vs. 23.52% younger 50 years), p = 0.016.

It is worth noting that the relationship between gender and severity in patients in the framework of this study was not confirmed, p > 0.05 - the differences are not significant .

The duration of hospital stay in the general structure did not significantly differ depending on gender. The average duration of treatment in men was 18.95±1.14 days, in women - 19.12±1.08 days, p >0.05 - the differences are not significant , while it was found that male patients who were discharged with clinical improvement within two weeks from the date of hospitalization, was a percentage greater than women, p = 0.043.

The vast majority, namely 84.09% of men and 84.09% of women, of hospitalized patients had subfebrile body temperature, while the numerical indicators were at the level of 37.36 ± 0.1℃ in men, and in women 37 .36+- 0.09℃.

Febrile body temperature was recorded among 21.05% of women and was at the level of 38.26+-0.04℃, (against 38.52 ± 0.05℃ in 20.45% of men). Pyretic body temperature was detected in only one woman (1.75%) and in 1 man (2.27%), while hyperpyretic temperature was not recorded.

The degree of blood oxygen saturation in percentage terms did not significantly differ depending on sex and amounted to 94.58±0.69% in women, 94.6±0.79% in men, p>0.05 - differences are not significant.

There were no significant and statistically significant gender differences in terms of the degree of lung tissue damage, p>0.05. A mild degree of damage (CT-1) was established in 13.63% of cases in men, while in women this figure was at the level of 12.28%, the average degree of damage in both sexes (CT-2) prevailed, which amounted to 40 .9% for men and 50.87% for women.

Significant damage to the lung tissue (CT-3) was recorded in 27.27% of men, 29.82% among women, and severe forms (CT-4) were detected only in 7.01% of women.

The indicators of general and biochemical blood tests do not differ significantly depending on gender ( p >0.05). Upon admission to the hospital in men, an increase in the erythrocyte sedimentation rate (ESR=29.95±2.4 mm/h ), concentration of C-reactive protein (CRP=52.19±8.21 mg/l ) and ferritin ( S - FER =458.59±64.49 µg/l), the concentration of leukocytes in the blood was in the reference values - 6.86 ±0.58* 10 9 /l ; a similar situation occurred in women: ESR=29.47±2.06 mm/h ; CRP=48.68±7.82 mg/l ; S - FER \u003d 462.34 ± 52.25 μg / l , leukocytes - 6.53 ± 3.13 * 10 9 / l. With a second blood test of patients before discharge from the hospital, the indicators stabilize relatively, which manifests itself in the form of a decrease in ESR (in women - 20.88 ± 1.75 mm / hour ; in men - 20.51 ± 2.2 mm / hour ); ferritin (in women - 367.59 ± 51.07 μg / l ; in men - 432.3 ± 62.11 μg / l ); CRP (in women - 17.9 ± 3.13 mg / l ; in men - 15.29 ± 2.98 mg / l ), the concentration of leukocytes in the blood is within the normal range: in women - 7.45 ± 0, 39* 10 9 /l; in men - 7.61 ± 0.55 * 10 9 / l). The dynamics and numerical values of the main parameters of general and biochemical blood tests do not significantly differ depending on gender, p >0.05.

The treatment of patients was complicated by the presence of concomitant pathologies in some of them. As is known from recent studies, the metabolic syndrome, which includes such deviations as obesity, hypertension, elevated levels of glucose and cholesterol in the blood, has a great influence on the course of coronavirus infection in the direction of aggravation. In the absence of adequate treatment and correction of the manifestations of this syndrome, persistent deviations develop, which manifest themselves in the form of corresponding chronic pathologies, mainly of the cardiovascular and endocrine systems. Among all hospitalized patients, arterial hypertension was recorded in 53.46℅, manifestations of atherosclerosis in 43.56℅, coronary artery disease - in 18.81℅, type 2 diabetes mellitus - in 18.81℅.

In men with С ovid -19, arterial hypertension at admission was detected in 43.16% of patients (against 61.4% in women), coronary heart disease in 22.73% (against 15.79% in women), atherosclerosis vessels - in 38.63% (against 43.37% - in women). Significant differences were not obtained, p >0.05.

The length of stay in the hospital for patients with Covid -19 and cardiovascular diseases (hypertension, atherosclerosis, coronary heart disease) did not reach statistical significance depending on gender and was 18.7±1.27 days for men and 19 days for women .9±1.0 day.

Gender differences also did not reach significance ( p >0.05) in relation to the duration of treatment of hospitalized patients with COVID -19 and endocrine pathology in the form of type 2 diabetes: the indicator among men was 18.7 ± 1.27 days, among women - 19.9 ± 1.01 days.

Discussion

The increased mortality among men diagnosed with the novel coronavirus infection in the early stages of the pandemic could be associated with the peculiarities of the male mentality. Men are less likely to seek medical help, less likely to complain. It is possible that the later presentation for a new infection was the main reason for the higher mortality rate. Significant differences were obtained in relation to the severity of the condition of patients depending on age. In younger patients up to 50 years of age, a satisfactory condition was more often recorded, a moderate course - in an older age group, which is explained by the presence of chronic pathologies of various functional systems.

Conclusion

The study did not reveal significant differences between men and women in relation to the severity of the disease, terms of hospitalization, clinical manifestations of the disease, comorbidities. The percentage of male patients who were discharged with clinical improvement within two weeks of admission was higher than that of female patients.

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About the authors

Vladislav Viktorovich Sidorov

Voronezh State Medical University named after N.N. Burdenko

Email: vladrf@bk.ru
ORCID iD: 0000-0002-7091-644X
SPIN-code: 1176-2840

student

Russian Federation, 394036, Russia, Voronezh, st. Student, 10

Elena Alexandrovna Medvedeva

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: len4onokk@mail.ru
ORCID iD: 0000-0001-5784-8844
SPIN-code: 4886-1720

student

Russian Federation, 394036, Russia, Voronezh, st. Student, 10

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