Background:
Myocardial injury is associated with higher mortality of COVID-19 and more complicated disease course. Little is known about sex differences in COVID-19-associated myocardial injury. We hypothesized that sex modifies the relationship between myocardial injury and severe COVID-19 infection.
Methods:
This is a cross-sectional study of all hospitalized patients with COVID-19 at a large health system in New York City between 3/2/20 - 5/12/20. We defined severe COVID-19 infection as ICU admission, mechanical ventilation, discharge to hospice, or death. Using multivariable logistic regression, we assessed whether sex modified the effect of peak troponin on the odds of severe COVID-19 infection, adjusting for demographics, co-morbidity, and laboratory values, and did the same for D-dimer.
Results:
Among 2,746 patients hospitalized with COVID-19, 650 (23.7%) required ICU admission, 648 (23.7%) required mechanical ventilation, and 680 (24.8%) died or were discharged to hospice. Peak troponin was higher in men than women (median 0.06, interquartile range [IQR] 0.01- 0.10 vs. 0.05 [IQR 0.01-0.10], p=0.02). Men were more likely to be admitted to the ICU and to receive mechanical ventilation (Table). After adjustment for demographics, medical history and other laboratory values, peak troponin level was associated with higher odds of severe COVID-19 illness: OR 1.51 per ng/mL, 95% CI 1.27-1.88, p<0.001. This association was modified by sex: the OR for severe COVID-19 per ng/mL peak troponin was 1.30 in women (95% CI 1.11-1.65) and 1.92 (95% CI 1.42-2.78) in men, p-interaction=0.047. There was no interaction between sex and D-dimer on severe COVID-19.
Conclusions:
Sex modifies the relationship between myocardial injury and severe COVID-19, with men having higher odds of severe COVID-19 infection associated with increasing peak troponin. Sex differences in myocardial injury may play a role in poorer outcome among men.
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