Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy.
Intensive Care Respiratory Unit, Mantova, Italy.
Andrology. 2021 Jan;9(1):88-98. doi: 10.1111/andr.12821. Epub 2020 Jun 3.
The pandemic of new severe acute respiratory syndrome (SARS) due to coronavirus (CoV) 2 (SARS-CoV-2) has stressed the importance of effective diagnostic and prognostic biomarkers of clinical worsening and mortality. Epidemiological data showing a differential impact of SARS-CoV-2 infection on women and men have suggested a potential role for testosterone (T) in determining gender disparity in the SARS-CoV-2 clinical outcomes.
To estimate the association between T level and SARS-CoV-2 clinical outcomes (defined as conditions requiring transfer to higher or lower intensity of care or death) in a cohort of patients admitted in the respiratory intensive care unit (RICU).
A consecutive series of 31 male patients affected by SARS-CoV-2 pneumonia and recovered in the respiratory intensive care unit (RICU) of the "Carlo Poma" Hospital in Mantua were analyzed. Several biochemical risk factors (ie, blood count and leukocyte formula, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), ferritin, D-dimer, fibrinogen, interleukin 6 (IL-6)) as well as total testosterone (TT), calculated free T (cFT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were determined.
Lower TT and cFT were found in the transferred to ICU/deceased in RICU group vs groups of patients transferred to IM or maintained in the RICU in stable condition. Both TT and cFT showed a negative significant correlation with biochemical risk factors (ie, the neutrophil count, LDH, and PCT) but a positive association with the lymphocyte count. Likewise, TT was also negatively associated with CRP and ferritin levels. A steep increase in both ICU transfer and mortality risk was observed in men with TT < 5 nmol/L or cFT < 100 pmol/L.
Our study demonstrates for the first time that lower baseline levels of TT and cFT levels predict poor prognosis and mortality in SARS-CoV-2-infected men admitted to RICU.
新型严重急性呼吸系统综合征（SARS）冠状病毒 2（SARS-CoV-2）的大流行凸显了有效诊断和预后生物标志物对临床恶化和死亡率的重要性。流行病学数据表明，SARS-CoV-2 感染对女性和男性的影响存在差异，这表明睾丸酮（T）在确定 SARS-CoV-2 临床结局的性别差异方面可能发挥作用。
在因 SARS-CoV-2 肺炎而入住呼吸重症监护病房（RICU）的患者队列中，评估 T 水平与 SARS-CoV-2 临床结局（定义为需要转入更高或更低强度的护理或死亡的情况）之间的关联。
对 31 名因 SARS-CoV-2 肺炎而入住曼图亚“Carlo Poma”医院 RICU 的男性患者进行了连续系列分析。测定了几种生化危险因素（即血细胞计数和白细胞公式、C 反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）、铁蛋白、D-二聚体、纤维蛋白原、白细胞介素 6（IL-6））以及总睾丸酮（TT）、计算游离 T（cFT）、性激素结合球蛋白（SHBG）和黄体生成素（LH）。
与转入 ICU/死于 RICU 组相比，转入 IM 或在 RICU 中稳定的患者组的 TT 和 cFT 较低。TT 和 cFT 与生化危险因素（即中性粒细胞计数、LDH 和 PCT）呈负相关，但与淋巴细胞计数呈正相关。同样，TT 也与 CRP 和铁蛋白水平呈负相关。在 TT<5nmol/L 或 cFT<100pmol/L 的男性中，观察到 ICU 转移和死亡率风险急剧增加。
本研究首次表明，较低的基线 TT 和 cFT 水平预测 SARS-CoV-2 感染男性入住 RICU 的预后不良和死亡率。
