Sex differences among inpatients with AECOPD in a tertiary hospital during the COVID-19 pandemic

Although sex differences in the characteristics and prognosis of chronic obstructive pulmonary disease (COPD) are well-documented, it is overlooked in the acute exacerbation of COPD (AECOPD). We aimed to examine sex differences among patients with AECOPD who were hospitalized in a tertiary hospital during the pandemic. This retrospective study included 199 females and 199 males among 2426 AECOPD patients who were hospitalized between March 2020 and 2022. Characteristics, modified Charlson Comorbidity Index (mCCI) scores, and long-term survival rate were compared based on sex. Associations between sex and variables were analyzed using the Chi-Square test. Females were older than males (P = 0.02). Females had higher body mass index and pulmonary function test values than males (P = 0.00 for both). GOLD 3, comorbidities, radiological findings, respiratory failure, and biomass exposure were more frequent in females, whereas smoking was more frequent in males (P = 0.00 for all). Among the causes of exacerbations, cardiac events and pneumonia were more frequent in females (P = 0.00 and P = 0.01, respectively), whereas tracheobronchial infections were more frequent in males (P = 0.02). Exacerbations and hospitalizations in the previous year were more prevalent in females than in males (P = 0.00); however, exacerbations during the pandemic were less prevalent (P = 0.00). Hemoglobin, hematocrit, and platelet/lymphocyte levels were higher in males than in females (P = 0.00, P = 0.00, and P = 0.04). Males were more likely than females to have received the BioNTech vaccine (P = 0.02). Compared with males, females had higher mCCI scores and lower 10-year life expectancies (P = 0.00 for both). Females with a COVID-19 history had higher mCCI scores and lower 10-year life expectancies than males with a COVID-19 history (P = 0.00 for both). The long-term survival rate was higher in females than in males (P = 0.04). The sex-specific characteristics identified in this study may help guide the management of AECOPD in future pandemics.