Abstract
PurposeObjective of this study was to assess the association between testosterone (T) levels and biochemical markers in a cohort of female patients admitted for SARS-CoV-2 infection in a respiratory intensive care unit (RICU).MethodsA consecutive series of 17 women affected by SARSCoV-2 pneumonia and recovered in the RICU of the Hospital of Mantua were analyzed. Biochemical inflammatory markers as well as total testosterone (TT), calculated free T (cFT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were determined.ResultsTT and cFT were significantly and positively associated with PCT, CRP, and fibrinogen as well as with a worse hospital course. We did not observe any significant association between TT and cFT with LH; conversely, both TT and cFT showed a positive correlation with cortisol. By LOWESS analysis, a linear relationship could be assumed for CRP and fibrinogen, while a threshold effect was apparent in the relationship between TT and procalcitonin, LDH and ferritin. When the TT threshold value of 1 nmol/L was used, significant associations between TT and PCT, LDH or ferritin were observed for values above this value. For LDH and ferritin, this was confirmed also in an age-adjusted model. Similar results were found for the association of cFT with the inflammatory markers with a threshold effect towards LDH and ferritin with increased LDH and ferritin levels for values above cFT 5 pmol/L. Cortisol is associated with serum inflammatory markers with similar trends observed for TT; conversely, the relationship between LH and inflammatory markers had different trends.ConclusionOpposite to men, in women with SARS-CoV-2 pneumonia, higher TT and cFT are associated with a stronger inflammatory status, probably related to adrenal cortex hyperactivity,
Highlights
The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly around the world in the last few months, resulting in more than 106 million persons globally infected and 2316 million deaths as of February 9, 2021.The clinical manifestations of SARS-CoV-2 infection are extremely different, encompassing asymptomatic infections and life-threatening Acute Respiratory Distress Syndrome (ARDS)
We found that total T (TT) below 5 nmol/L and calculated free T below 100 pmol/L were associated with a steep increase of circulating neutrophil, procalcitonin (PCT) and lactate dehydrogenase (LDH), while only TT was negatively associated with C-reactive protein, CRP, and ferritin levels
Blood samples were drawn on the first morning after the admission to the respiratory intensive care unit (RICU) within 8.00 AM, in fasting condition, for the determination of blood count and leukocyte formula, creatinine, uric acid, electrolytes, transaminases, albumin, creatine phosphokinase (CPK), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), ferritin, D-dimer, fibrinogen, interleukin 6 (IL-6), TT, sex hormone–binding globulin (SHBG), cortisol and luteinizing hormone (LH)
Summary
The clinical manifestations of SARS-CoV-2 infection are extremely different, encompassing asymptomatic infections and life-threatening Acute Respiratory Distress Syndrome (ARDS). This clinical heterogeneity and the rapid evolution of this new pandemic syndrome made urgent the identification of pathogenic mechanisms underlying the heterogeneity and possible risk factors [1,2,3]. TT < 5 nmol/L and cFT < 100 pmol/L were associated with a 20–40% lower likelihood of improving their clinical conditions This evidence was perfectly in line with the well-documented protective effects of testosterone in several inflammatory diseases. An age-related androgen decline in men has been correlated with the clinical course, in terms of either outcomes or comorbidities, of several inflammatory and autoimmune diseases [11]
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