Pituitary-gonadal hormones associated with respiratory failure in men and women hospitalized with COVID-19: an observational cohort study.

Abstract

To explore pituitary-gonadal hormone concentrations and assess their association to inflammation, severe respiratory failure and mortality in hospitalized men and women with coronavirus disease 2019 (COVID-19) and compare these to hormone concentrations in hospitalized patients with bacterial community-acquired pneumonia (CAP), influenza virus CAP, and to concentrations in a reference group of healthy individuals. Serum concentrations of testosterone, estrone sulfate, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and interleukin-6 (IL-6) were measured within three days of admission. Associations were assessed by logistic regression analysis in patients with COVID-19, and results were reported as odds ratio with 95% confidence interval per two-fold reduction after adjustment for age, comorbidities, days to sample collection, and IL-6 concentrations. In total 278 with COVID-19, 21 with influenza virus CAP, and 76 with bacterial CAP were included. Testosterone concentrations were suppressed in men hospitalized with COVID-19, bacterial- and influenza virus CAP and moderately suppressed in women. Reductions in testosterone (OR 3.43 [1.14-10.30], p=0.028) and LH (OR 2.51 [1.28-4.92], p=0.008) were associated higher odds of mechanical ventilation (MV) in men with COVID-19. In women with COVID-19, reductions in LH (OR 3.34 [1.02-10-90], p=0.046) and FSH (OR 2.52 [1.01-6.27], p=0.047) were associated with higher odds of MV. Low testosterone and LH concentrations were predictive of severe respiratory failure in men with COVID-19, whereas low concentrations of LH and FSH predicted severe respiratory failure in women with COVID-19.