Sex-specific clinical characteristics and prognosis of coronavirus disease-19 infection in Wuhan, China: A retrospective study of 168 severe patients

PLoS Pathog. 2020 Apr 28;16(4):e1008520. doi: 10.1371/journal.ppat.1008520. eCollection 2020 Apr.


To confirm the relationship between sex and the progression of Coronavirus Disease-19 (COVID-19), and its potential mechanism, among severe patients. For this retrospective study, we included 168 consecutive severe patients with pathogen-confirmed COVID-19 who were hospitalized between January 16th and February 4th, 2020, at Tongji Hospital in Wuhan, China. Clinical characteristics, laboratory parameters, and outcomes were compared and analyzed between males and females. In the present study, we analyzed 168 severe patients with COVID-19, including 86 males and 82 females, and 48 patients (28.6%) were diagnosed as critically ill. Of 86 male patients, 12.8% (11/86) died and 75.6% (65/86) were discharged; of 82 female patients, 7.3% (6/82) died and 86.6% (71/82) were discharged. Eleven laboratory parameters showed significant differences between male and female patients, and six of them were higher during the whole clinical course in patients who died than in patients who were discharged. In adjusted logistic regression analysis, males with comorbidities presented a higher risk of being critically ill than males without comorbidities (OR = 3.824, 95% CI = 1.279-11.435). However, this association attenuated to null in female patients (OR = 2.992, 95% CI = 0.937-9.558). A similar sex-specific trend was observed in the relation between age and critically ill conditions. We highlighted sex-specific differences in clinical characteristics and prognosis. Male patients appeared to be more susceptible to age and comorbidities. Sex is an important biological variable that should be considered in the prevention and treatment of COVID-19.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Child
  • Child, Preschool
  • Comorbidity
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / pathology*
  • Disease Progression
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / pathology*
  • Prognosis
  • SARS-CoV-2
  • Sex Factors
  • Young Adult

Grants and funding

This work was supported by the research-oriented clinician funding program of Tongji Medical College, Huazhong University of Science and Technology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.