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Federal government websites often end in. The site is secure. Epidemiological, demographic and clinical features, and inflammatory indexes were collected and compared between males and females. The multiple linear regression method was used to explore the influence of sex on inflammation reaction. Males had higher mortality than females did Excess innate immunity and proinflammation activity, and deficiency in adaptive immunity response promote males, especially elder males, to develop a cytokine storm, causing potential acute respiratory distressed syndrome, multiple organ failure and decease.

Written informed consent was waived in light of the urgent need to collect data. The laboratorial, radiological features, and outcome data from electronic medical records in the hospital were retrieved and reviewed by two trained physicians.

Patients were defined to be mild or severe during hospitalization on the basis of the guidance of the American Thoracic Society and Infectious Diseases Society of America.

The definitions of complications were described in our previous study. The clinical outcomes were classified into survival and nonsurvival. Continuous variables were expressed as medians and interquartile ranges IQR. Categorical variables were presented as numbers and rates. All statistical analyses were performed using the SPSS software version Among all the cases, Of the patients, As of 3 March , 90 of Males had a mortality of The relative risk RR of mortality was 2.

Besides this, the survival rate of patients especially males dropped quickly in the first 15 days from hospitalization and then gradually turned to be stable. Compared with female patients, males had higher rates of severe patients, smokers, chronic obstructive pulmonary disease COPD , coronary heart disease CHD , lymphopenia, and thrombocytopenia, and greater levels of inflammation indexes, and suffered from hypoxia, worse renal and liver function, and higher frequency of complications Table SE1.

It was notable that no difference existed between the age distribution of males and females. In agreement with the results of all patients, sex, and age both had significant influences on CFR, and the elder severe male patients had the greatest CFR, that is, Recent research has demonstrated that patients with comorbidities had greater disease severity compared with those without. After adjusting for age, smoking history, and comorbidity, male patients were more likely to reach the endpoint than females did HR, 1.

Compared with patients without comorbidity, patients with one comorbidity had an HR of 1. Two hundred and thirty three of patients without smoking history had cytokine data available. The patients were classified into three subgroups based on severity, and there were mild patients, 92 severe patients, and 18 deceased patients. Besides this, the lymphocyte count in peripheral blood showed a trend of lower levels in male patients. C, Lymphocyte count in peripheral blood.

On the basis of sex and comorbidity, the patients were divided into four subgroups: males without comorbidity, females without comorbidity, males with comorbidity, and females with comorbidity. Patients with comorbidity had greater age, severe rate and CFR, while there was no difference between comorbidity number of males and females Table 2. With or without comorbidity, patients in the male groups had higher levels of ferritin and hsCRP compared with female groups. P values, overall P values among four groups.

In this way, sex, age, hypertension, and diabetes were chosen to perform multiple linear regression, through which the correlations between sex and inflammatory proteins and cytokines adjusted by age, hypertension, and diabetes were studied Figure 4B. In this study, the ratio of severity and death was In this study, there were 62 of 90 Male and female patients both showed increasing mortality with aging, among whom elder patients were more likely to reach the endpoint, and cases with comorbidity especially two or more comorbidities were more susceptible to die compared to those without.

Besides this, smoking history, however, had no significant influence on mortality after adjustment of gender, age, and comorbidity. As Guan et al 20 pointed out in a paradoxical result, the possible reasons could be that patients with smoking history were mainly male, but sex was not considered in their study; and the study populations were also different.

Consequently, elder patients, especially males with comorbidity, were recommended to receive timely diagnosis, medical care and close monitoring.

In viral infections, the aberrant release of proinflammatory factors could lead to lung epithelial and endothelial cell apoptosis which damaged the lung microvascular and alveolar epithelial cell barrier, causing alveolar edema, hypoxia, and even ARDS. Meanwhile, cytokine storm could also result in immunopathogenic damage to tissues and organs. Males and females had different innate immune responses, which could be related to the innate detection of nucleic acids by pattern recognition receptors between sexes, and innate immune responses of sex hormones.

This study had some limitations. First, this retrospective study was single central, with all patients enrolled from the Tongji Hospital, and the interpretation of our findings might be limited by the sample size.

Second, not all laboratory tests, especially inflammatory proteins and cytokines, were performed on all patients. Fourth, cases with some comorbidities such as asthma and tumor were limited, there is still a lack of detailed investigation on their effects on inflammation and severity. In summary, male patients especially elder patients with comorbidity, showed a higher risk of mortality. MX and LQ conceived and designed the study. LQ and MX contributed to the literature search and writing of the report.

All authors provided a critical review of the manuscript and approved the final draft for publication. J Med Virol. Published online Jun Author information Article notes Copyright and License information Disclaimer.

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