In-depth Analysis of Laboratory Parameters Reveals the Interplay Between Sex, Age and Systemic Inflammation in Individuals with COVID-19

ten-Caten, Felipe; Gonzalez-Dias, Patrícia; Castro, Ícaro; Ogava, Rodrigo L.T.; Giddaluru, Jeevan; Silva, Juan Carlo S.; Martins, Felipe; Gonçalves, André N.A.; Costa-Martins, André G.; Araujo, José D.; Viegas, Ana Carolina; Cunha, Fernando Q.; Farsky, Sandra; Bozza, Fernando A.; Levin, Anna S.; Pannaraj, Pia S.; de Silva, Thushan I.; Minoprio, Paola; Pinheiro da Silva, Fabiano; Andrade, Bruno B.; Nakaya, Helder I.

Background The progression and severity of COVID-19 varies significantly in the population. While the hallmarks of SARS-CoV-2 and severe COVID-19 within routine laboratory parameters are emerging, the impact of sex and age on these profiles is still unknown. Methods We performed multidimensional analysis of millions of records of laboratory parameters and diagnostic tests for 178,887 individuals from Brazil, of which 33,266 tested positive for SARS-CoV-2. These included complete blood cell count, electrolytes, metabolites, arterial blood gases, enzymes, hormones, cancer biomarkers, and others. Findings COVID-19 induced similar alterations in laboratory parameters in males and females. CRP and ferritin were increased especially in older men with COVID-19, whereas abnormal liver function tests were common across several age groups, except for young women. Low peripheral blood basophils and eosinophils were more common in the elderly with COVID-19. Both male and female COVID-19 patients admitted to intensive care units displayed alterations in the coagulation system, and higher values of neutrophils, CRP and lactate dehydrogenase. Conclusions Our study uncovers the laboratory profile of a large cohort of COVID-19 patients that underly discrepancies influenced by aging and biological sex. These profiles directly link COVID-19 disease presentation to an intricate interplay between sex, age and immune activation.