OBJECTIVE Male sex is one of the determinants of severe coronavirus diseas-e-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19. METHODS We performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation (IMV), death, intensive care unit (ICU) admission and home discharge at day 7 (D7) or day 28 (D28)) in 2380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736). RESULTS The study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR: 0.66 (0.49-0.88)), death (OR: 0.49 (0.30-0.79)) and ICU admission (OR: 0.57 (0.43-0.77)) at D7 but only with ICU admission (OR: 0.58 (0.43-0.77)) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, C-reactive protein (CRP), aspartate amino transferase (AST) and estimated glomerular filtration rate (eGFR), according to the CKD-EPI formula predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only. CONCLUSIONS In patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.

中文翻译：

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糖尿病住院患者 COVID-19 结果的性别差异：来自 CORONADO 研究的见解。

目标 男性是严重冠状病毒疾病 e-2019 (COVID-19) 的决定因素之一。我们旨在描述因 COVID-19 住院的糖尿病成人严重结局的性别差异。方2380 名糖尿病患者因 COVID-19 住院，并被纳入全国 CORONADO 观察性研究 (NCT04324736)。结果 研究人群主要为男性（63.5%）。经过多次调整后，女性与主要结局（IMV 和/或死亡，OR：0.66（0.49-0.88））、死亡（OR：0.49（0.30-0.79））和入住 ICU（OR：0.57（0.43 -0。77)）在 D7 时，但仅在 D28 时进入 ICU（或：0.58 (0.43-0.77)）。年龄较大和微血管并发症病史是男女在第 28 天死亡的预测因素，而慢性阻塞性肺病 (COPD) 仅可预测女性的死亡。根据 CKD-EPI 公式，入院时，C 反应蛋白 (CRP)、天冬氨酸氨基转移酶 (AST) 和估计的肾小球滤过率 (eGFR) 可预测男女死亡。淋巴细胞减少症仅是女性死亡的独立预测因子，而血小板减少症和血浆葡萄糖浓度升高仅是男性死亡的预测因子。结论 在因 COVID-19 入院的糖尿病患者中，女性与早期严重结局的发生率较低相关，但不影响总体住院死亡率，表明糖尿病减轻了女性对 COVID-19 严重程度的保护。与性别相关的生物学决定因素可能有助于优化女性和男性的 COVID-19 预防和管理。