Background Although biological males and females are equally likely to become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evidence has mounted that males experience higher severity and fatality compared to females. Main The objective of this review is to examine the existing literature on biological mechanisms underlying sex-based differences that could contribute to SARS-CoV-2 infection clinical outcomes. Sex-based differences in immunologic response and hormonal expression help explain the differences in coronavirus disease 2019 (COVID-19) outcomes observed in biological males and females. X inactivation facilitates a robust immune response to COVID-19 in females, who demonstrate a more profound antibody response and faster recovery when compared to males. Low testosterone levels also help explain the dysregulated inflammatory response and poor outcomes observed in some males with COVID-19. Gender differences in health expression and behaviors further compound these observed differences. Conclusion Understanding the biology of sex-based differences in COVID-19 severity and mortality could help inform preventative measures, treatment decisions, and development of personalized, sex-specific therapies. Highlights Although most COVID-19 patients develop only mild disease, some mount a pronounced inflammatory response that results in severe pneumonia, respiratory failure, and death. Male sex is a known risk factor for severe outcomes in COVID-19. Biological sex-based differences in COVID-19 severity and mortality are influenced by genetic and hormonal differences at the cellular and immunologic level. Biological sex-based differences are further complicated by environmental factors, namely social and cultural norms, that define gender roles which impact risk of infection and severe outcomes. Understanding sex-based differences in COVID-19 outcomes will help inform clinical decision algorithms and treatment strategies to optimize the care of COVID-19 patients.
【저자키워드】 COVID-19, SARS-CoV-2, Sex, Gender, 【초록키워드】 Treatment, coronavirus disease, coronavirus, immune response, Respiratory failure, Mortality, SARS-COV-2 infection, severity, Antibody Response, Genetic, COVID-19 severity, outcome, risk factor, clinical outcomes, outcomes, Health, Algorithm, male, female, death, understanding, Mild, severe pneumonia, disease, expression, Care, mechanism, COVID-19 patients, Therapies, fatality, cellular, Evidence, Inflammatory response, risk of infection, treatment strategy, COVID-19 patient, Biological, immunologic response, acute respiratory syndrome, environmental factors, help, clinical decision, preventative measures, females, males, robust, develop, facilitate, contribute, faster, dysregulated, explain, mounted, with COVID-19, X inactivation, 【제목키워드】 severe COVID-19, Clinical outcome, mechanism,