Inflammation parameters predict fatal outcome in male COVID-19 patients in a low case-fatality area – a population-based registry study

Abstract

Background

Male sex predicts case-fatality in SARS-CoV-2 (COVID-19) – a phenomenon linked to systemic inflammation. We compared sex-related associations of inflammation parameters and outcome in a population-based setting with low case-fatality prior to wide use of immunosuppressives.

Methods

A population-based quality registry with laboratory-confirmed COVID-19 cases of specialized hospitals of the Capital Province of Finland were analysed to compare inflammatory parameters by sex during the first COVID-19 wave February–June 2020.

Results

Altogether, 585 hospitalized patients (54% males) were included. Males required more often intensive care unit (ICU) treatment (26.9 vs. 17.5%) and had higher 90-d case-fatality (14.9 vs. 7.8%) compared with females. Highest association with case-fatality in males was seen for high neutrophil counts (median; interquartile range) (8.70; 7.10–9.10 vs. 5.60; 3.90–7.80) (E9/l), low monocyte (0.50; 0.20–1.50 vs. 0.70; 0.50–0.90) (E9/l) and lymphocyte (0.90; 0.70-1.40 vs. 1.50; 1.10-2.00) (E9/l) counts, and high levels of d-dimer (3.80; 1.80–5.30 vs. 1.10; 0.60–2.75) (mg/l) and C-reactive protein (CRP) (190; 85.5–290 vs. 77.0; 49.0–94.0) (mg/l). In females, low lymphocyte (0.95; interquartile range 0.60–1.28 vs. 1.50; 1.10–2.00) (E9/l) and thrombocyte counts (196; 132–285 vs. 325; 244–464) (E9/l) and high CRP values (95.0; 62.0–256 vs. 66.0; 42.5–89.0) (mg/l) were associated with case-fatality. In multivariable analysis for males, lymphocyte cut-off 0.85 (E9/l) (OR 0.02; 95% CI 0.002–0.260), d-dimer cut-off 1.15 (mg/l) (OR 7.29; 1.01–52.6) and CRP cut-off 110 (mg/l) (OR 15.4; 1.87–127) were independently associated with case-fatality. In female multivariable analysis, CRP cut-off 81 (mg/l) (OR 7.32; 1.44–37.2) was the only inflammatory parameter associated with case-fatality.

Conclusions

COVID-19 results in higher inflammation parameter levels in male vs. female patients irrespective of outcome. This study suggests that low lymphocyte, high d-dimer and high CRP cut-off values may serve as potential markers for risk stratification in male patients.

Keywords:

• Inflammatory parameters
• COVID-19
• prognosis
• case-fatality
• sex-related differences

Disclosure statement

AJ reports speaker honoraria from Astellas, GlaxoSmithKline, Gilead, Sanofi, ThermoFisher and consultation fees from Gilead, GlaxoSmithKline, Sanofi, Sobi and Roche outside the scope of this publication. AM and SS none.

Additional information

Funding

EF and AJ have received a grant from Wilhelm and Else Stockmann Foundation.