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.