Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available. A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27–June 11, 2020). Clinical characteristics and the times from symptoms’ onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex. Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39–2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29–2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13–1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55–0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25–0.63), yet both sexes had a high level of multimorbidity. The times from symptoms’ onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45–5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13–1.90). Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

中文翻译：

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意大利死于COVID-19的个体在临床表型和护理过渡方面的性别差异

在2019年冠状病毒疾病（COVID-19）爆发所带来的未知数中，生物性别在解释疾病易感性和进展方面的作用仍然是一个辩论的话题，但按性别分类的数据有限。进行了一项回顾性分析，以评估意大利死于实验室确诊的SARS-CoV-2感染的住院患者的临床表现和护理过渡是否存在性别差异（2020年2月27日至6月11日）。比较了两性的临床特征以及从症状发作到入院，鼻咽拭子和死亡的时间。进行调整后的多元分析以鉴定与男性相关的临床特征。在意大利发生的32938例与COVID-19相关的死亡中，有3517例因COVID-19住院和死亡的人（平均78±12岁，对33％的女性进行了分析。入院时，男性患缺血性心脏病（adj-OR = 1.76，95％CI 1.39–2.23），慢性阻塞性肺疾病（adj-OR = 1.7，95％CI 1.29–2.27）和慢性肾脏病的患病率更高（adj-OR = 1.48，95％CI 1.13-1.96），而女性年龄较大，更容易患痴呆症（adj-OR = 0.73，95％CI 0.55-0.95）和自身免疫性疾病（adj-OR = 0.40，95） ％CI 0.25–0.63），但两性都有较高的多发病率。尽管有典型的急性呼吸系统疾病，但发烧频率更高，男性从症状发作到入院和鼻咽拭子的时间略长。男性接受实验治疗的频率更高（adj-OR = 2.89，95％CI 1.45–5.74），并且发生急性肾脏损伤的可能性更高（adj-OR = 1.47，95％CI 1.13-1.90）。死于COVID-19的男性和女性具有不同的临床表现和护理过渡。确定具有COVID-19和致命结局的个体的性别特征可能有助于采取预防措施。