Low testosterone levels as an independent risk factor for mortality in male patients with COVID-19: Report of a Single-Center Cohort Study in Mexico / Niveles bajos de testosterona como factor de riesgo independiente de mortalidad en pacientes masculinos con COVID-19: Informe de un estudio de cohorte de un solo centro en México

Introduction and objectives: Throughout the coronavirus disease 2019 (COVID-19) pandemic, a greater severity and lethality of the disease has been highlighted in male patients, so we set out to evaluate the prognostic role of serum testosterone levels in the clinical results of this population. Methods: In this single-center and cross-sectional design, we included male patients admitted to our hospital with COVID-19 confirmed diagnosis. The biochemical analysis included lymphocytes, lactate dehydrogenase (LDH), total testosterone (TT), dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone. Receiver operating characteristic curves, univariate and bivariate analysis, and binary logistic regression for multivariate analysis were performed. A p value<0.05 was consider significant. Results: From 86 men included, 48.8% died. TT levels were lower in non-survivor patients than in survivor patients (4.01nmol/L [0.29–14.93] vs 5.41 (0.55–25.08) nmol/L, p=0.021). The independent risk factors that increased the relative risk (RR) of dying from COVID-19 were: age>59 years (RR 3.5 [95% IC 1.0–11.6], p=0.045), TT levels<4.89nmol/L (RR 4.0 [95% IC 1.2–13.5], p=0.027) and LDH levels>597IU/L (RR 3.9 [95% IC 1.2–13.1], p=0.024). Patients who required mechanical ventilation (p=0.025), had lymphopenia (p=0.013) and LDH levels>597IU/L (p=0.034), had significantly lower TT levels compared to those who did not present these conditions. There were no differences in TT levels between patients who had or did not have comorbidities. Conclusions: A TT level<4.89nmol/L increase four times the RR of death from COVID-19 in men, regardless of age or presence of comorbidities. (AU)

Introducción y objetivos: A lo largo de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19), se ha destacado una mayor gravedad y letalidad de la enfermedad en pacientes del sexo masculino, por lo que nos propusimos evaluar el papel pronóstico de los niveles séricos de testosterona en los resultados clínicos de esta población. Métodos: En este diseño transversal de un único centro, incluimos a pacientes masculinos ingresados en nuestro hospital con diagnóstico confirmado de COVID-19. El análisis bioquímico incluyó linfocitos, lactato deshidrogenasa (LDH), testosterona total (TT), dehidroepiandrosterona, hormona estimulante del folículo y hormona luteinizante. Se elaboraron curvas «característica operativa del receptor», análisis univariado y bivariado y regresión logística binaria para análisis multivariado. Se consideró significativo un valor de p<0,05. Resultados: De los 86 hombres incluidos, el 48,8% falleció. El nivel de TT fue más bajo en los pacientes no supervivientes que en los supervivientes (4,01 [0,29-14,93] nmol/L vs. 5,41 [0,55-25,08] nmol/L; p=0,021). Los factores de riesgo independientes que aumentaron el riesgo relativo (RR) de muerte por COVID-19 fueron: edad>59 años (RR 3,5: IC 95% 1,0-11,6; p=0,045), cifra de TT<4,89 nmol/L (RR 4,0; IC 95%: 1,2-13,5; p=0,027) y de LDH>597 UI/L (RR 3,9; IC 95%: 1,2-13,1; p=0,024). Los pacientes que requirieron ventilación mecánica (p=0,025), tenían linfopenia (p=0,013), un nivel de LDH>597 UI/L (p=0,034) y de TT significativamente más bajos que aquellos que no presentaban estas condiciones. No hubo diferencias en los niveles de TT entre los pacientes que tenían o no comorbilidades. Conclusiones: Un nivel de TT<4,89 nmol/L aumenta 4 veces el RR de muerte por COVID-19 en hombres, independientemente de la edad o la presencia de comorbilidades. (AU)

Low testosterone levels as an independent risk factor for mortality in male patients with COVID-19: Report of a Single-Center Cohort Study in Mexico.

INTRODUCTION AND OBJECTIVES: Throughout the coronavirus disease 2019 (COVID-19) pandemic, a greater severity and lethality of the disease has been highlighted in male patients, so we set out to evaluate the prognostic role of serum testosterone levels in the clinical results of this population. METHODS: In this single-center and cross-sectional design, we included male patients admitted to our hospital with COVID-19 confirmed diagnosis. The biochemical analysis included lymphocytes, lactate dehydrogenase (LDH), total testosterone (TT), dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone. Receiver operating characteristic curves, univariate and bivariate analysis, and binary logistic regression for multivariate analysis were performed. A p value<0.05 was consider significant. RESULTS: From 86 men included, 48.8% died. TT levels were lower in non-survivor patients than in survivor patients (4.01nmol/L [0.29-14.93] vs 5.41 (0.55-25.08) nmol/L, p=0.021). The independent risk factors that increased the relative risk (RR) of dying from COVID-19 were: age>59 years (RR 3.5 [95% IC 1.0-11.6], p=0.045), TT levels<4.89nmol/L (RR 4.0 [95% IC 1.2-13.5], p=0.027) and LDH levels>597IU/L (RR 3.9 [95% IC 1.2-13.1], p=0.024). Patients who required mechanical ventilation (p=0.025), had lymphopenia (p=0.013) and LDH levels>597IU/L (p=0.034), had significantly lower TT levels compared to those who did not present these conditions. There were no differences in TT levels between patients who had or did not have comorbidities. CONCLUSIONS: A TT level<4.89nmol/L increase four times the RR of death from COVID-19 in men, regardless of age or presence of comorbidities.

[Alterations in cerebral perfusion in patients with systemic sclerosis and cognitive impairment]. / Alteraciones en la perfusión cerebral en pacientes con esclerosis sistémica y deterioro cognitivo.

INTRODUCTION: Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, immunological and vascular abnormalities. Cerebral hypoperfusion can be caused by cerebral ischemia. Cognitive impairment (CI) are a major cause of morbidity in SSc The aim of this study is to estimate the frequency of alterations in cerebral perfusion (CP) in SSc patients with CI. METHODS: We studied 88 patients with SSc. The Montreal Test (MT) was given to all patients to evaluate CI. To 15 patients with CI and without systemic hypertension, diabetes mellitus, cerebrovascular disease, vasculitis, hypothyroidism, depression, and drugs that interfere with the cognitive assessment, the PC was measured by cerebral gammagram (CG). RESULTS: Of the 88 patients with ES, 58 had CI by MT. A decrease in CP was observed in following lobes: frontal in 9 of 15 patients, temporal in 7 of 15, and parietal in 3 of 15. Concordance between MT and CG was 60% for the frontal, 46% for the temporal and parietal 13%. CONCLUSIONS: The CI is common in SSc. A decrease in CP was more frequent in the frontal lobe, predominating in older patients and with longer duration of SSc.

Introducción: la esclerosis sistémica (ES) es una enfermedad autoinmune, sistémica, caracterizada por fibrosis, alteraciones inmunológicas y vasculares. La hipoperfusión cerebral puede ser causada por isquemia. Los trastornos cognitivos son causa importante de morbilidad. El objetivo de este estudio fue determinar la frecuencia de alteraciones en la perfusión cerebral (PC) en pacientes con ES y deterioro cognitivo (DC). Métodos: se estudiaron 88 pacientes con ES. A todos se les aplicó el Test de Montreal (TM) para evaluar el DC. A 15 pacientes con DC que cumplieron con los criterios (sin hipertensión arterial sistémica, diabetes mellitus, evento vascular cerebral, vasculitis, hipotiroidismo, depresión, sin ingesta de fármacos que interfieran con la evaluación cognitiva), se les midió la PC mediante Gamagrama Cerebral Perfusorio (GCP).Resultados: de los 88 pacientes con ES, 58 tuvieron DC con el TM. La PC se encontró disminuida en 12/15. La disminución de la PC se observó en los siguientes lóbulos (frontal en 9/15; temporal en 7/15, y parietal en 3/15. La concordancia entre el TM y GC fue 60 % para el lóbulo frontal, 46 % para el lóbulo temporal y 13 % parietal.Conclusiones: el DC es frecuente en la ES, la disminución de la PC fue más común en el lóbulo frontal, predominado en los pacientes de mayor edad y tiempo de evolución de la ES.