Biochemical differences based on sex and clusters of biomarkers in patients with COVID-19: analysis from the CARDIO COVID 19–20 registry

Cañón-Estrada F.; Muñoz-Ordoñez J.A.; Escalante-Forero M.; Rodas Y.; Arteaga-Tobar A.A.; Azcarate-Rodriguez V.; Perna E.; Mendoza I.; Wyss F.; Barisani J.L.; Speranza M.; Alarco W.; Ortega J.C.; Ulate A.; Mercedes J.; Chaves D.Q.; Oliver P.; Valencia-Orozco A.; Barbosa M.M.; León-Giraldo H.; Flórez N.A.; Gómez-Mesa J.E.; Castillo E.; Morr I.; Herrera C.; Almonte C.; Galindo W.G.Y.; Sol Sol F.C.; Correa R.M.; Fernández F.N.G.; Quintana M.; Romero A.; Sierra D.; Alvarado A.; Chong F.P.; Aguirre M.; Aldaz L.P.C.; Sandoval S.; Saldarriaga C.I.; Orozco W.M.; Ortíz J.I.; Buitrago A.; Rodríguez M.J.; Fernández H.F.; Lugo J.; Rossel V.; Ramírez R.R.; Criollo I.; Thomas F.V.; Gómez R.E.L.; Florit F.A.; Montenegro C.E.; Figueiredo E.L.; Passos L.C.S.; Schwartzmann P.; Brunialti J.M.; Silva P.; Christen A.I.; Coronel M.L. · BMC Cardiovascular Disorders (2025) · DOI: 10.1186/s12872-025-04565-3

Resumen

Background: The inflammatory response associated with COVID-19 varies with sex, potentially affecting disease outcomes. Males have a higher risk of complications compared to females, requiring an evaluation of differences in inflammatory response severity based on sex. Objective: To compare clinical data, biochemical biomarkers, and outcomes among hospitalized COVID-19 patients in Latin America and the Caribbean (LA&C) based on sex and to perform a cluster analysis of biomarker profiles for both sexes. Methods: This prospective, multicenter observational registry made by the Inter-American Council of Heart Failure and Pulmonary Hypertension of the Inter-American Society of Cardiology included hospitalized COVID-19 patients from 44 hospitals in 14 countries in LA&C between May 1, 2020, and June 30, 2021. Results: Of 3,260 patients (1,201 females and 2,059 males), males had higher C-reactive protein and ferritin levels, while females had higher natriuretic peptides and d-dimer levels. Males had more cardiovascular complications (acute coronary syndrome [3.3% vs. 2.2%], decompensated heart failure [8.9% vs. 7.8%], pulmonary embolism [4.4% vs. 2.9%]), intensive care unit (ICU) admissions (56.9% vs. 47.7%), and overall mortality (27.5% vs. 22.1%). Cluster analysis identified three groups: one with normal-range biomarkers but elevated ferritin, one with coagulation abnormalities, and one with an inflammatory profile linked to renal injury and increased non-cardiovascular mortality. Conclusions: In the LA&C population hospitalized with COVID-19, males had higher inflammatory biomarker levels, correlating with increased cardiovascular complications and mortality. The cluster with an inflammatory profile showed higher non-cardiovascular mortality, while clusters with elevated ferritin levels were associated with increased ICU admissions. © The Author(s) 2025.