Background Males and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take the sex factor into consideration. Methods We performed a sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels of 1558 males and 1499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. The total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence. Results We found that male patients had approximately two-fold rates of ICU admission (4.7% vs. 2.7% in males and females, respectively, P = 0.005) and mortality (3% vs. 1.4%, in males and females, respectively, P = 0.004) than female patients. Survival analysis revealed that the male sex is an independent risk factor for death from COVID-19 (adjusted hazard ratio [HR] = 2.22, 95% confidence interval [CI]: 1.3–3.6, P = 0.003). The level of inflammatory cytokines in peripheral blood was higher in males during hospitalization. The renal (102/1588 [6.5%] vs. 63/1499 [4.2%], in males and females, respectively, P = 0.002) and hepatic abnormality (650/1588 [40.9%] vs. 475/1499 [31.7%], P = 0.003) were more common in male patients than in female patients. By analyzing dynamic changes of lymphocyte subsets after symptom onset, we found that the percentage of CD19+ B cells and CD4+ T cells was generally higher in female patients during the disease course of COVID-19. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in female patients, while gradually increased and reached a peak in the seventh week after symptom onset in male patients. Conclusions Males had an unfavorable prognosis, higher inflammation, a lower percentage of lymphocytes, and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06313-2.
【저자키워드】 COVID-19, immunology, SARS-CoV-2, Prognosis, Sex, 【초록키워드】 Inflammation, coronavirus, Cytokines, Lymphocytes, Mortality, Trial, Hospitalization, spike, antibody, T cells, SARS-COV-2 infection, Antibody Response, B cells, Lymphocyte subsets, severe acute respiratory syndrome Coronavirus, flow cytometry, clinical outcomes, Spike protein, Receptor binding domain, Peripheral blood, B cell, Protein, lymphocyte, Lymphocyte subset, Comparative analysis, male, female, Patient, ICU admission, death, immune cells, CD4+ T cells, Pathogens, Inflammatory cytokines, nucleoprotein, respiratory, change, chemiluminescence, patients, CD4+ T cell, Inflammatory cytokine, COVID-19 patients, Clinical practice, Protective, Immunological response, Analysis, survival analysis, Male sex, COVID-19 patient, Cytometry, Flow, CD19, symptom onset, acute respiratory syndrome, supplementary material, acute respiratory syndrome coronavirus, 95% confidence interval, adjusted hazard ratio, disease course, IgG levels, Female patients, single center, independent risk factor, renal, close monitoring, abnormality, lymphocyte subgroups, specific IgM, CD19+, medical intervention, RBD-specific IgG, females, indolent, Course, Result, performed, the disease, reached, were measured, female patient, gradually increased, IgG level, lymphocyte subgroup, 【제목키워드】 immunological,