Abstract
Objectives: To investigate the association between sex hormones and the severity of coronavirus disease 2019 (COVID-19). Furthermore, associations between sex hormones and systemic inflammation markers, viral shedding and length of hospital stay were studied.
Design and methods: This case-control study included a total of 48 male patients with COVID-19 admitted to an Italian reference hospital. The 24 cases were patients with PaO 2 /FiO 2 <250 mmHg and who needed ventilatory support during hospitalization (severe COVID-19). The 24 controls were selected in a 1:1 ratio, matched by age, from patients who maintained PaO 2 /FiO 2 >300 mmHg at all times and who may have required low-flow oxygen supplementation during hospitalization (mild COVID-19). For each group, sex hormones were evaluated on hospital admission.
Results: Patients with severe COVID-19 (cases) had a significantly lower testosterone level compared with patients with mild COVID-19 (controls). Median total testosterone (TT) was 1.4 ng/mL in cases and 3.5 ng/mL in controls (P = 0.005); median bioavailable testosterone (BioT) was 0.49 and 1.21 in cases and controls, respectively (P = 0.008); and median calculated free testosterone (cFT) was 0.029 ng/mL and 0.058 ng/mL in cases and controls, respectively (P = 0.015). Low TT, low cFT and low BioT were correlated with hyperinflammatory syndrome (P = 0.018, P = 0.048 and P = 0.020, respectively) and associated with longer length of hospital stay (P = 0.052, P = 0.041 and P = 0.023, respectively). No association was found between sex hormone level and duration of viral shedding, or between sex hormone level and mortality rate.
Conclusions: A low level of testosterone was found to be a marker of clinical severity of COVID-19.
Keywords: Androgen sensitivity; Gender imbalance; SARS-CoV-2; Severity markers; Sex hormones; Testosterone.
【저자키워드】 SARS-CoV-2, Testosterone, Sex hormones, Androgen sensitivity, Gender imbalance, Severity markers, 【초록키워드】 COVID-19, coronavirus disease, Coronavirus disease 2019, severe COVID-19, Hospitalization, severity, hospital, viral shedding, Sex, Testosterone, oxygen, Sex hormones, Viral, Hyperinflammatory syndrome, male, Patient, Control, Mild, age, Hospital admission, systemic inflammation, mortality rate, case-control study, association, Gender imbalance, marker, Clinical severity, androgen, Hospital stay, ventilatory support, sex hormone, free testosterone, mmHg, significantly lower, controls, Italian, low-flow oxygen supplementation, selected, evaluated, required, median, calculated, correlated, 1:1, PaO, patients with COVID-19, 【제목키워드】 Biomarker, severe pneumonia, pathogenic, role,