Characterization of Clinical Features of Hospitalized Patients Due to the SARS-CoV-2 Infection in the Absence of Comorbidities Regarding the Sex: An Epidemiological Study of the First Year of the Pandemic in Brazil

Nathália Mariana Santos Sansone; Letícia Rogini Pereira; Matheus Negri Boschiero; Felipe Eduardo Valencise; Andréa Melo Alexandre Fraga; Fernando Augusto Lima Marson

doi:10.3390/ijerph19158895

Characterization of Clinical Features of Hospitalized Patients Due to the SARS-CoV-2 Infection in the Absence of Comorbidities Regarding the Sex: An Epidemiological Study of the First Year of the Pandemic in Brazil

Int J Environ Res Public Health. 2022 Jul 22;19(15):8895. doi: 10.3390/ijerph19158895.

Authors

Nathália Mariana Santos Sansone^{1

2}, Letícia Rogini Pereira^{1

2}, Matheus Negri Boschiero^{1

2}, Felipe Eduardo Valencise^{1

2}, Andréa Melo Alexandre Fraga³, Fernando Augusto Lima Marson^{1

2}

Affiliations

¹ Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, University of São Francisco, Bragança Paulista, São Paulo 12916-9003, Brazil.
² Laboratory of Human and Medical Genetics, University of São Francisco, Bragança Paulista, São Paulo 12916-9003, Brazil.
³ Department of Pediatrics, University of Campinas, Campinas, São Paulo 13083-887, Brazil.

Abstract

The male sex, due to the presence of genetic, immunological, hormonal, social, and environmental factors, is associated with higher severity and death in Coronavirus Disease (COVID)-19. We conducted an epidemiological study to characterize the COVID-19 clinical profile, severity, and outcome according to sex in patients with the severe acute respiratory syndrome (SARS) due to the fact of this disease. We carried out an epidemiological analysis using epidemiological data made available by the OpenDataSUS, which stores information about SARS in Brazil. We recorded the features of the patients admitted to the hospital for SARS treatment due to the presence of COVID-19 (in the absence of comorbidities) and associated these characteristics with sex and risk of death. The study comprised 336,463 patients, 213,151 of whom were men. Male patients presented a higher number of clinical signs, for example, fever (OR = 1.424; 95%CI = 1.399−1.448), peripheral arterial oxygen saturation (SpO2) < 95% (OR = 1.253; 95%CI = 1.232−1.274), and dyspnea (OR = 1.146; 95%CI = 1.125−1.166) as well as greater need for admission in intensive care unit (ICU, OR = 1.189; 95%CI = 1.168−1.210), and the use of invasive ventilatory support (OR = 1.306; 95%CI = 1.273−1.339) and noninvasive ventilatory support (OR = 1.238; 95%CI = 1.216−1.260) when compared with female patients. Curiously, the male sex was associated only with a small increase in the risk of death when compared with the female sex (OR = 1.041; 95%CI = 1.023−1.060). We did a secondary analysis to identify the main predictors of death. In that sense, the multivariate analysis enabled the prediction of the risk of death, and the male sex was one of the predictors (OR = 1.101; 95%CI = 1.011−1.199); however, with a small effect size. In addition, other factors also contributed to this prediction and presented a great effect size, they are listed below: older age (61−72 years old (OR = 15.778; 95%CI = 1.865−133.492), 73−85 years old (OR = 31.978; 95%CI = 3.779−270.600), and +85 years old (OR = 68.385; 95%CI = 8.164−589.705)); race (Black (OR = 1.247; 95%CI = 1.016−1.531), Pardos (multiracial background; OR = 1.585; 95%CI = 1.450−1.732), and Indigenous (OR = 3.186; 95%CI = 1.927−5.266)); clinical signs (for instance, dyspnea (OR = 1.231; 95%CI = 1.110−1.365) and SpO2 < 95% (OR = 1.367; 95%CI = 1.238−1.508)); need for admission in the ICU (OR = 3.069; 95%CI = 2.789−3.377); and for ventilatory support (invasive (OR = 10.174; 95%CI = 8.803−11.759) and noninvasive (OR = 1.609; 95%CI = 1.438−1.800)). In conclusion, in Brazil, male patients tend to present the phenotype of higher severity in COVID-19, however, with a small effect on the risk of death.

Keywords: Brazil; COVID-19; SARS-CoV-2; androgens; epidemiology; sex.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brazil / epidemiology
COVID-19* / epidemiology
Dyspnea
Epidemiologic Studies
Female
Hospitalization
Humans
Intensive Care Units
Male
Pandemics*
SARS-CoV-2

Grants and funding

The student M.N.B. was awarded a scholarship by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo; no. 2021/05810-7), and the student F.E.V. was awarded a scholarship by FAPESP (no. 2021/08437-5). The student L.R.P. was awarded a scientific initiation scholarship by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).