Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study

in European Journal of Endocrinology
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  • 1 B Tramunt, Department of Diabetology, Metabolic Diseases and Nutrition, University Hospital Centre Toulouse, Toulouse, France
  • 2 S Smati, Department of Endocrinology, Diabetology and Nutrition, Institut du thorax, Nantes, France
  • 3 S Coudol, CIC-EC 1413, Data Clinic, University Hospital Centre Nantes, Nantes, France
  • 4 M Wargny, L’institut du thorax, CHU Nantes, INSERM CIC1413, CHU Nantes Clinique d'Endocrinologie, Nantes, France
  • 5 M Pichelin, Clinique d'endocrinologie, Maladies Métaboliques et Nutrition, Centre Hospitalier Universitaire de Nantes, Nantes, 44093, France
  • 6 B Guyomarch, Research Department, Methodology and Biostatistics Platform, University Hospital Centre Nantes, Nantes, France
  • 7 A Al-Salameh, Department of Endocrinology, Diabetes Mellitus and Nutrition, University Hospital Centre Amiens-Picardie, Amiens, France
  • 8 C Amadou, Department of Diabetology, Sud Francilien Hospital Center, Corbeil Essonne, United Kingdom of Great Britain and Northern Ireland
  • 9 S Barraud, Endocrinology, CHU Reims, Reims, 51100, France
  • 10 É Bigot, Department of Biochemistry, Nantes University Hospital, University Hospital Centre Nantes, Nantes, France
  • 11 L Bordier, Department of Endocrinology, Military Training Hospital Begin, Saint Mande, France
  • 12 S Borot, Endocrinology, Centre Hospitalier Universitaire de Besançon, Besancon, 25030, France
  • 13 M Bourgeon, Department of Endocrinology, Diabetology and Nutrition, Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, France
  • 14 O Bourron, Department of diabetology, Sorbonne Université, Paris, 75005, France
  • 15 S Charriere, Federation of Endocrinology , Hopital Cardio-vasculaire et Pneumologique Louis Pradel, Lyon, France
  • 16 N Chevalier, Reproductive Endocrinology and Diabetologia, University Hospital of Nice - L'archet 2, Nice Cedex 3, France
  • 17 E Cosson, Department of Endocrinology, Diabetology and Nutrition, Hopital Jean-Verdier Service d'Endocrinologie Diabetologie et Nutrition, Bondy, France
  • 18 B Fève, Department of Endocrinology, Hospital Saint-Antoine, Paris, France
  • 19 A Flaus-Furmaniuk, Department of Endocrinology-Diabetology, Felix Guyon University Hospital Center, Saint-Denis, Réunion
  • 20 P Fontaine, Department of Endocrinology, Diabetology and Nutrition, Claude Huriez Hospital, Lille, France
  • 21 A Galioot, Department of Endocrinology, Diabetology and Nutrition, University Hospital Centre Bordeaux, Bordeaux, France
  • 22 C Gonfroy-Leymarie, Department of Endocrinology and Diabetology, Hospital of Pontoise, Pontoise, France
  • 23 B Guerci, Endocrinology, Diabetology, Metabolic Diseases and Nutrition, University Hospital Centre Nancy, Nancy, France
  • 24 S Lablanche, Endocrinology, Grenoble Alpes University Hospital, Grenoble, France
  • 25 J Lalau, Department of Endocrinology, CHU Amiens-Picardie, Amiens, France
  • 26 E Larger, Department of Diabetology, Hospital Cochin, Paris, France
  • 27 A Lasbleiz, Department of Endocrinology, Diabetology and Nutrition, Hospital of la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
  • 28 B Laviolle, Inserm, CIC 1414 , University Hospital Centre Rennes, Rennes, France
  • 29 M Marre, Ambroise Paré Neuilly-sur-Seine Hospital, Cordeliers Research Centre, Paris, France
  • 30 M Munch, Department of Endocrinology, Diabetology and Nutrition, University Hospitals Strasbourg, Strasbourg, France
  • 31 L Potier, Department of Endocrinology, Diabetology and Nutrition, Hôpital Bichat Claude-Bernard, Paris, France
  • 32 G Prévost, DC2N, Université de Rouen, Mont Saint Aignan, 76821, France
  • 33 E Renard, Department of Endocrinology, Diabetes, Nutrition, University Hospital Centre Montpellier, Montpellier, France
  • 34 Y Reznik, Endocrinologie et Maladies Métaboliques, CHU de Caen, Caen, 14033, France
  • 35 D Seret-begue, Department of Diabetology, Centre Hospitalier de Gonesse, Gonesse, France
  • 36 P Sibilia, Department of Endocrinology, Diabetology and Nutrition, University Hospital Centre Angers, Angers, France
  • 37 P Thuillier, Endocrinology, CHU Brest, Brest, 29200, France
  • 38 B Vergès, Endocrinologie, Diabétologie, CHU Dijon, Hôpital du Bocage, Dijon, 21000, France
  • 39 J Gautier, Diabetes and Endocrinology, DHU FIRE, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, France
  • 40 S Hadjadj, L’institut du thorax, CHU Nantes, INSERM CIC1413, CHU Nantes Clinique d'Endocrinologie, Nantes, France
  • 41 B Cariou, Department of Endocrinology, Diabetology and Nutrition, Institut du thorax, Nantes, France
  • 42 F Mauvais-Jarvis, Diabetes Discovery and Sex-Based Medicine Laboratory, Section of Endocrinology, John W Deming Department of Medicine, Tulane University Health Sciences Center, new orleans, United States
  • 43 P Gourdy, Department of Diabetology, Metabolic Diseases and Nutrition, University Hospital Centre Toulouse, Toulouse, France

Correspondence: Pierre Gourdy, Email: pierre.gourdy@inserm.fr

Objective:

Male sex is a determinant of severe coronavirus disease-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 2,380 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, CRP, AST and eGFR 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.

 

     European Society of Endocrinology

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