ArticleBMC infectious diseases2021
Sex-based clinical and immunological differences in COVID-19.
Article in BMC infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers.
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Who cites it
35 citing papers in PubMed, 215 citations in OpenAlex.
- Viral shedding and symptom severity across populations during acute COVID in the ACTIV-2 study.medRxiv : the preprint server for health sciences · 2026Article
- Severity-dependent metabolic rewiring in COVID-19 based on untargeted metabolomic profiling of patient plasma.PloS one · 2026Article
- Impact of Sex on Viral Shedding and Symptom Severity During Acute COVID-19.Pathogens & immunity · 2026Article
- Decoding long COVID-associated cardiovascular dysfunction: Mechanisms, models, and new approach methodologies.Journal of molecular and cellular cardiology · 2025Review
- Prognostic Impact of Vaccination, Comorbidity, and Inflammatory Biomarkers on Clinical Outcome in Hospitalized Patients with COVID-19.Biomedicines · 2025Article
- COVID-19 Infection in Pediatric Patients Presenting to a Tertiary Center in Jordan: Clinical Characteristics and Age-Related Patterns.Journal of clinical medicine · 2025Article
- IgM has a better relative distribution in inflammation sites and tumor tissues than IgG.Journal of nanobiotechnology · 2025Article
- Nanomaterial-Based Biosensors for the Detection of COVID-19.Indian journal of microbiology · 2025Article
- Sex differences and immune correlates of Long Covid development, symptom persistence, and resolution.Science translational medicine · 2024Article
- COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Review
- Article
- Seroprevalence of SARS-CoV-2 Antibodies and Associated Factors in Bamako, Mali: A Population-Based Cross-Sectional Study in September 2022.Influenza and other respiratory viruses · 2024Article
- Sex differences and immune correlates of Long COVID development, persistence, and resolution.bioRxiv : the preprint server for biology · 2024Article
- Longitudinal dynamic clinical phenotypes of in-hospital COVID-19 patients across three dominant virus variants in New York.International journal of medical informatics · 2024Article
- COVID-19 Serological Study in Non-infected Vaccinated Subjects: Differences among Age, Sex, and Vaccine Brand.Puerto Rico health sciences journal · 2023Article
- SARS-CoV-2 infection and female reproductive health: A narrative review.Best practice & research. Clinical endocrinology & metabolism · 2023Review
- SARS-CoV-2 antibody responses associate with sex, age and disease severity in previously uninfected people admitted to hospital with COVID-19: An ISARIC4C prospective study.Frontiers in immunology · 2023Article
- Establishment of sex-specific predictive models for critical illness in Chinese people with the Omicron variant.Frontiers in microbiology · 2023Article
- One-Year Follow-Up of COVID-19 Patients Indicates Substantial Assay-Dependent Differences in the Kinetics of SARS-CoV-2 Antibodies.Microbiology spectrum · 2022Article
- Interferon-λ treatment accelerates SARS-CoV-2 clearance despite age-related delays in the induction of T cell immunity.Nature communications · 2022Article
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Authors and funding
18 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundMales and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take the sex factor into consideration.
methodsWe performed a sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels of 1558 males and 1499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. The total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence.
resultsWe found that male patients had approximately two-fold rates of ICU admission (4.7% vs. 2.7% in males and females, respectively, P = 0.005) and mortality (3% vs. 1.4%, in males and females, respectively, P = 0.004) than female patients. Survival analysis revealed that the male sex is an independent risk factor for death from COVID-19 (adjusted hazard ratio [HR] = 2.22, 95% confidence interval [CI]: 1.3-3.6, P = 0.003). The level of inflammatory cytokines in peripheral blood was higher in males during hospitalization. The renal (102/1588 [6.5%] vs. 63/1499 [4.2%], in males and females, respectively, P = 0.002) and hepatic abnormality (650/1588 [40.9%] vs. 475/1499 [31.7%], P = 0.003) were more common in male patients than in female patients. By analyzing dynamic changes of lymphocyte subsets after symptom onset, we found that the percentage of CD19+ B cells and CD4+ T cells was generally higher in female patients during the disease course of COVID-19. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in female patients, while gradually increased and reached a peak in the seventh week after symptom onset in male patients.
conclusionsMales had an unfavorable prognosis, higher inflammation, a lower percentage of lymphocytes, and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients.
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