Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure / Deficiência de Testosterona Aumenta Readmissão Hospitalar e Mortalidade em Pacientes do Sexo Masculino com Insuficiência Cardíaca

Background:Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown.Objective:We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF.Methods:Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients.Results:Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001).Conclusion:These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

Fundamento:A deficiência de testosterona na insuficiência cardíaca (IC) está associada à diminuição da capacidade de exercício e mortalidade, mas o seu impacto sobre as readmissões é incerto. Além disso, sua relação com a ativação simpática é desconhecida.Objetivo:O presente estudo investigou o papel dos níveis de testosterona nas reinternações hospitalares, na mortalidade e na atividade nervosa simpática em pacientes com IC.Métodos:A testosterona total (TT) e a testosterona livre (TL) foram medidas em 110 pacientes do sexo masculino hospitalizados, com fração de ejeção < 45% eclassificação funcional da New York Heart Association (NYHA) IV, qualificados em dois grupos: 66 com baixos níveis de testosterona (BT) e 44 com testosterona normal (TN). Hipogonadismo foi definido como TT < 300 ng/dL e TL < 131 pmol/L. A atividade nervosa simpática muscular (ANSM) foi gravada por microneurografia em uma subpopulação de 27 pacientes.Resultados:O tempo de permanência hospitalar foi maior em pacientes BT em comparação com pacientes TN (37 ± 4 vs. 25 ± 4 dias; p = 0,008). Da mesma forma, o risco cumulativo de readmissão no período de um ano foi maior em pacientes BT (44% vs. 22%, p = 0,001). Na análise de uma única variável preditora, a testosterona total (HR = 2,77, IC 95% 1,58-4,85, p = 0,02) previu readmissão hospitalar no prazo de 90 dias. Na análise de uma única variável preditora, testosterona total (HR = 4,65, IC 95% 2,67-8,10, p = 0,009) e readmissão dentro de 90 dias (HR = 3,27, IC 95% 1,23-8,69, p = 0,02) previram aumento de mortalidade. Ativação neuro-humoral, estimada pela ANSM, foi significativamente maior nos pacientes BT em comparação aos do grupo TN (65 ± 3 vs. 51 ± 4 disparos/100BC; p < 0,001).Conclusão:Estes resultados sustentam o conceito de que BT é um fator de risco independente para a readmissão hospitalar dentro de 90 dias e para aumento de mortalidade em pacientes com IC. Além disso, observou-se aumento da ANSM em pacientes com baixos níveis de testosterona.

Testosterone deficiency increases hospital readmission and mortality rates in male patients with heart failure.

BACKGROUND: Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. OBJECTIVE: We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. METHODS: Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients. RESULTS: Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58-4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67-8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23-8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001). CONCLUSION: These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.