The associations of age, sex, and comorbidities with survival of hospitalized patients with coronavirus disease 2019: data from 4014 patients from a tertiary-center registry

Aim To investigate how age, sex, and comorbidities affect the survival of hospitalized coronavirus disease 2019 (COVID-19) patients. Methods We retrospectively analyzed the records of 4014 consecutive adults hospitalized for COVID-19 in a tertiarylevel institution from March 2020 to March 2021. Results The median age was 74 years. A total of 2256 (56.2%) patients were men. The median Charlson-comor - bidity-index (CCI) was 4 points; 3359 (82.7%) patients had severe or critical COVID-19. A significant interaction be - tween age, sex, and survival ( P <0.05) persisted after ad - justment for CCI. In patients <57 years, male sex was re - lated to a favorable (odds ration [OR] 0.50, 95% confidence interval [CI] 0.29-0.86), whereas in patients ≥57 years it was related to an unfavorable prognosis (OR 1.19, 95% CI 1.04- 1.37). Comorbidities associated with inferior survival inde - pendently of age, sex, and severe/critical COVID-19 on ad - mission were chronic heart failure, atrial fibrillation, acute myocardial infarction, acute cerebrovascular insult, history of venous thromboembolism, chronic kidney disease, ma - jor bleeding, liver cirrhosis, mental retardation, dementia, active malignant disease, metastatic malignant disease, autoimmune/rheumatic disease, bilateral pneumonia, and other infections on admission. Conclusion Among younger patients, female sex might lead to an adverse prognosis due to undisclosed reasons (differences in fat tissue distribution, hormonal status, and other mechanisms). Patient subgroups with specific co - morbidities require additional considerations during hos - pital stay for COVID-19. Future studies focusing on sex differences and potential interactions are warranted.