Implications of Sex Difference in CT Scan Findings and Outcome of Patients with COVID-19 Pneumonia

Abstract

Purpose The novel coronavirus pandemic has caused significant morbidity and mortality since December 2019. Although the role of chest CT for diagnosing COVID-19 pneumonia is still debatable, the modality has been used in scenarios of constrained real-time polymerase chain reaction (RT-PCR) testing. The epidemiologic reports indicate an unexplored difference between men and women in disease severity. We aimed to study the role of sex on disease severity and its correlation with CT-scan findings. Methods We retrospectively studied all confirmed cases of COVID-19 with thoracic CT-scans obtained at three hospitals from February 25, 2020 to March 15, 2020 in Tehran, Iran. CT involvement patterns of COVID-19 were analyzed based on sex and age of patients. Results One hundred and fifteen patients (64.3% [74/115] men) were enrolled with a median age of 57 (min:21, max:89). Thirty patients were admitted to the Intensive Care Unit (ICU), and thirty patients died during the hospital stay. Seventy-seven percent (37/48) of patients with unfavorable prognosis were males. Peripheral distribution of opacities was more common in males than females. When grouped by an age cut-off of 60 years, the females in the elder group had peribronchovascular distribution pattern, and younger males showed an anterior distribution of opacities. Females younger than 60 years had significantly lower CT-scores (7.5 ± 6.8). Receiver operating characteristic (ROC) curve analysis demonstrated a CT-score cut-off of 14.5 to have 100% sensitivity and 91.9% specificity for predicting poor prognosis in females younger than 60 years. Conclusion Opacity patterns on chest CT in COVID-19 are different based on sex and age, and males are at higher risk of disease severity and death.