Work

Response to Letter to the Editor From Nelson et al: “Understanding the Link Between Obesity and Severe COVID-19 Outcomes: Causal Mediation by Systemic Inflammatory Response”

Year: 2022

Type: letter

Abstract: We agree fully with Nelson et al (1) that rigor in the analysis of sex is critically important in studies of severe outcomes associated with SARS-CoV-2 infection, and particularly in investigations of obesity, inflammation, and the mechanistic underpinnings of severe disease. Indeed, in tandem to the article in JCEM (2), members of our team published an article specifically investigating biomarkers of cardiac injury, renal injury, and inflammation as potential mediators of sex-associated mortality among SARS-CoV-2–infected individuals (3). In other work, we report sex-stratified analyses in the study of signature biomarker states and mortality (4) and characterize sex differences in inflammatory markers among patients hospitalized with SARS-CoV-2 (5). Appropriate handling of sex as a potential moderator or confounder is of paramount importance and for over a decade, we have included this focus in our clinical and translational research, for instance (6, 7). We thank Nelson et al for highlighting this need, which we may have underemphasized in (2) as we were undertaking a much more comprehensive sex-specific analysis (3). Notably, this second article is published within the section on Sex and Gender in Cardiovascular Medicine, focused specifically on examining sex differences in outcomes. Importantly, we do want to clarify that, in our JCEM article (2), models were adjusted for sex and this fact was indicated throughout (see paragraph 2 of Statistical Methods, legend to Figure 1, footnote b of Table 2, and footnote b of Table 3). We fully endorse the SAGER guidelines (8) and concur unequivocally with Nelson et al that “Science needs to follow scientific principles and guidelines, especially when not following them introduces sex and gender bias.” The authors have nothing to disclose.

Source: The Journal of Clinical Endocrinology & Metabolism

DOI: 10.1210/clinem/dgac620