Endocrine Abstracts

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is showing a rapid and continuous evolution in terms of new waves, the spread of variants and the evidence of reinfections. The growing heterogeneity of clinical presentation requires the identification of underlying pathogenic mechanisms to allow a better risk stratification. Previous studies analysed the role of sex hormones in disease severity demonstrating in male patients the association of low testosterone (T) levels with unfavorable outcome of COVID-19. Conversely, data concerning the role of T in women with SARS CoV-2 infection are scant and limited to small cohorts.

Purpose: To investigate the relationship between serum T values and clinical presentation and outcome of SARS-CoV2-related pneumonia in a population of adult females admitted to hospital due to coronavirus-disease 19 (COVID-19).

Methods: All adult females hospitalized for COVID-19 in our Institution during the period between November 1^st 2020 and February 28^th 2021 were evaluated for arterial partial pressure oxygen (PaO2)/fraction of inspired oxygen (Fio2) ratio, serum T and inflammatory parameters (IL-6 and procalcitonin) at study entry, need of ventilation during hospital stay and in-hospital mortality. Berlin criteria were used to define acute respiratory insufficiency (ARI).

Results: The study included 101 women (mean age 76.8 ± 13.8 years, mean BMI 27.3 ± 6.3 kg/m² and mean T 1.333 ± 1.3 nmol/l). A significant correlation was observed between serum T levels and IL-6 (P< 0.044) and procalcitonin (P< 0.001). At hospital admission 55% (n=56) of subjects were diagnosed with ARI. No significant association was found between serum T levels and ARI (P=0.227). Mean duration for hospital stay was 14.2 ± 9.9 days, and mortality was 23% (n=25). Subjects who died had significantly higher age (83.7 ± 10, 5 vs 74.6 ± 14.1; P=0.033), IL-6 (89.3 ± 95.3 vs 35.9 ± 39.2;P=0.021) and procalcitonin levels (1.7 ± 4.0 vs 0.3 ± 1.7; P=0.001) as well as significantly lower fT3 levels (2.89 ± 0.55 vs 3.70 ± 0.80;P=0.007) as compared to survivors. No significant difference was observed in serum T levels among the two groups (P=0.604).

Conclusion: Oppositely to what observed in male subjects, this study provides a first preliminary evidence about the role of higher serum T levels in female as a mirror of higher inflammatory phenotype and worse COVID-19 disease course, possibly reflecting a massive adrenal cortex activation in response to systemic inflammation.