TY - JOUR
T1 - Association Between Sex Hormone Levels and Clinical Outcomes in Patients With COVID-19 Admitted to Hospital
T2 - An Observational, Retrospective, Cohort Study
AU - Beltrame, Anna
AU - Salguero, Pedro
AU - Rossi, Emanuela
AU - Conesa, Ana
AU - Moro, Lucia
AU - Bettini, Laura Rachele
AU - Rizzi, Eleonora
AU - D’Angió, Mariella
AU - Deiana, Michela
AU - Piubelli, Chiara
AU - Rebora, Paola
AU - Duranti, Silvia
AU - Bonfanti, Paolo
AU - Capua, Ilaria
AU - Tarazona, Sonia
AU - Valsecchi, Maria Grazia
N1 - Funding Information:
The research was funded by Italian Ministry of Health “Fondi Ricerca Corrente, Project L1P5” for IRCCS Sacro Cuore Don
Funding Information:
This work was conducted within the Circular Health Initiative promoted by the UF One Health Center. The authors thank the Covid&Sex Working Group for their support and fruitful regular discussions: AB, IC, Oriana Ciani, AC, Ana Lleo, Luca Mantegazza, Antonietta Mira, LM, Elisa Pasqual, CP, PS, and MV. We are grateful to all the staff of the Department of Infectious, Tropical Diseases and Microbiology IRCCS Sacro Cuore Don Calabria Hospital of Negrar di Valpolicella, including other personnel from the ward, the laboratory, and nurses. We also thank the STORM Working Group: Giacomo Bellani, Marina Cazzaniga, Giuseppe Citerio, Ernesto Contro, Giuseppe Foti, Alberto Pesci, and MV at the San Gerardo Hospital in Monza.
Publisher Copyright:
Copyright © 2022 Beltrame, Salguero, Rossi, Conesa, Moro, Bettini, Rizzi, D’Angió, Deiana, Piubelli, Rebora, Duranti, Bonfanti, Capua, Tarazona and Valsecchi.
PY - 2022/1/27
Y1 - 2022/1/27
N2 - Understanding the cause of sex disparities in COVID-19 outcomes is a major challenge. We investigate sex hormone levels and their association with outcomes in COVID-19 patients, stratified by sex and age. This observational, retrospective, cohort study included 138 patients aged 18 years or older with COVID-19, hospitalized in Italy between February 1 and May 30, 2020. The association between sex hormones (testosterone, estradiol, progesterone, dehydroepiandrosterone) and outcomes (ARDS, severe COVID-19, in-hospital mortality) was explored in 120 patients aged 50 years and over. STROBE checklist was followed. The median age was 73.5 years [IQR 61, 82]; 55.8% were male. In older males, testosterone was lower if ARDS and severe COVID-19 were reported than if not (3.6 vs. 5.3 nmol/L, p =0.0378 and 3.7 vs. 8.5 nmol/L, p =0.0011, respectively). Deceased males had lower testosterone (2.4 vs. 4.8 nmol/L, p =0.0536) and higher estradiol than survivors (40 vs. 24 pg/mL, p = 0.0006). Testosterone was negatively associated with ARDS (OR 0.849 [95% CI 0.734, 0.982]), severe COVID-19 (OR 0.691 [95% CI 0.546, 0.874]), and in-hospital mortality (OR 0.742 [95% CI 0.566, 0.972]), regardless of potential confounders, though confirmed only in the regression model on males. Higher estradiol was associated with a higher probability of death (OR 1.051 [95% CI 1.018, 1.084]), confirmed in both sex models. In males, higher testosterone seems to be protective against any considered outcome. Higher estradiol was associated with a higher probability of death in both sexes.
AB - Understanding the cause of sex disparities in COVID-19 outcomes is a major challenge. We investigate sex hormone levels and their association with outcomes in COVID-19 patients, stratified by sex and age. This observational, retrospective, cohort study included 138 patients aged 18 years or older with COVID-19, hospitalized in Italy between February 1 and May 30, 2020. The association between sex hormones (testosterone, estradiol, progesterone, dehydroepiandrosterone) and outcomes (ARDS, severe COVID-19, in-hospital mortality) was explored in 120 patients aged 50 years and over. STROBE checklist was followed. The median age was 73.5 years [IQR 61, 82]; 55.8% were male. In older males, testosterone was lower if ARDS and severe COVID-19 were reported than if not (3.6 vs. 5.3 nmol/L, p =0.0378 and 3.7 vs. 8.5 nmol/L, p =0.0011, respectively). Deceased males had lower testosterone (2.4 vs. 4.8 nmol/L, p =0.0536) and higher estradiol than survivors (40 vs. 24 pg/mL, p = 0.0006). Testosterone was negatively associated with ARDS (OR 0.849 [95% CI 0.734, 0.982]), severe COVID-19 (OR 0.691 [95% CI 0.546, 0.874]), and in-hospital mortality (OR 0.742 [95% CI 0.566, 0.972]), regardless of potential confounders, though confirmed only in the regression model on males. Higher estradiol was associated with a higher probability of death (OR 1.051 [95% CI 1.018, 1.084]), confirmed in both sex models. In males, higher testosterone seems to be protective against any considered outcome. Higher estradiol was associated with a higher probability of death in both sexes.
KW - ARDS
KW - COVID-19
KW - estradiol
KW - outcome
KW - severity
KW - sex hormones
KW - testosterone
UR - https://www.scopus.com/pages/publications/85124505209
U2 - 10.3389/fimmu.2022.834851
DO - 10.3389/fimmu.2022.834851
M3 - Article
C2 - 35154158
SN - 1664-3224
VL - 13
JO - Frontiers in immunology
JF - Frontiers in immunology
M1 - 834851
ER -
SDG 3 Good Health and Well-being