Androgenic status of men with severe COVID-19: the role of testosterone and dihydrotestosterone [within the program founder (features of a new coronavirus infection course and options therapy depending on the androgenic status)]

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Abstract

Purpose. The aim of this study was to assess the men’s androgen status influence on the severity and outcomes (transfer of patients to the ICU or death) of COVID-19 required hospital hospitalization.

Materials and methods. The study included 151 hospitalized men with a confirmed diagnosis of COVID-19. To measure the severity of disease have been used Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). It includes the severity of the clinical condition (hyperthermia, shortness of breath, oxygen saturation, need for ventilation), the degree of inflammation (CRP), markers of thrombosis (D-dimer), the degree of lung damage according to CT. The patients underwent a study of full blood count, some biochemical parameters, lung CT, and a study of testosterone (T) and dihydrotestosterone (DHT) levels.

Results. T deficiency was observed in 46.4% of patients (70/151 men). At the same time, DHT deficiency was observed only in 14.4% of patients (18/125 men). In patients with a T level below the median, there was a significant increase in inflammatory factors (CRP, lymphocytes/CRP index), markers of thrombosis (D-dimer and fibrinogen), extensive lung damage at admission according to CT 25.75% vs. 11.95% (p<0.001), the elevated number of points for SHOCKS-COVID 7 (IQR 5-10) versus 5 (IQR 3-7) (p<0.001) and the longer duration of hospital treatment (3 days difference, p<0.001) in comparison with a group of patients with a T level above the median. At the same time, the T level had no correlation with age. The level of DHT had a weak inverse correlation with the age of patients, but not with the main markers of the severity of COVID-19, including the number of SHOCK-COVID scores.

During multivariate regression analysis, it was shown that SHOCKS-COVID is the most significant predictor of admission to the ICU while no association of T and DHT levels with outcomes in COVID-19 was found. However, it was found that the concentration of T, even adjusted for age, has a significant inverse association with the severity of the course of the disease and the number of SHOCK-COVID scores (p=0.041). An analysis of the evaluation of directed acyclic graphs suggests the main role of COVID-19 severity in reducing androgenic function and T concentration, at which its anti-inflammatory effects are lost. There were no correlations between the concentration of DHT and the number of SHOCK-COVID scores and the COVID-19 prognosis.

Conclusion. SHOCK-COVID is the most sensitive predictor of the COVID-19 outcome in hospitalized men, including adjusting to age. T and DHT do not directly affect the outcomes of the disease. The greater severity of the infection and an increase in SHOCK-COVID scores are associated with a decrease in the concentration of T, and a weakening of its anti-inflammatory and anti-cytokine effects, which indirectly worsens the prognosis of male patients with a new coronavirus infection undergoing hospital treatment. There are no such relationships for DHT.

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About the authors

A. A. Kamalov

Lomonosov Moscow State University

Email: armais.kamalov@rambler.ru

Professor, Academician RAS, Dr.Sc. (Med), Director, Medical Research and Education Center; Head of the Department of Urology and Andrology, Faculty of Medicine

Russian Federation, Moscow

O. Yu. Nesterova

Lomonosov Moscow State University

Author for correspondence.
Email: oy.nesterova@gmail.com

Urologist; Trainee Researcher of the Scientific Department of Urology and Andrology

Russian Federation, Moscow

V. Yu. Mareev

Lomonosov Moscow State University

Email: prof_mareev@ossn.ru

Professor, Dr.Sc. (Med), chief scientific researcher Medical Research and Education Center

Russian Federation, Moscow

Ia. A. Orlova

Lomonosov Moscow State University

Email: YAOrlova@mc.msu.ru

Dr.Sc. (Med), head of Department of Age-Associated Diseases; head of the Department of Therapy, Medical Research and Education Center

Russian Federation, Moscow

Yu. V. Mareev

Lomonosov Moscow State University; National Medical Research Centre for Therapy and Preventive Medicine

Email: mareev84@gmail.com

Ph.D. (Med.), senior researcher, Department of Age-Associated Diseases, Medical Research and Education Center; chief scientific researcher Department of Cardiology

Russian Federation, Moscow; Moscow

Yu. L. Begrambekova

Lomonosov Moscow State University

Email: julia.begrambekova@ossn.ru

Ph.D. (Med.), leading researcher, Department of Age-Associated Diseases, Medical Research and Education Center; Associate Professor of the Department of Therapy, Faculty of Fundamental Medicine

Russian Federation, Moscow

Z. Sh. Pavlova

Lomonosov Moscow State University

Email: zukhra73@gmail.com

Ph.D. (Med.), leading researcher, Department of Age-Associated Diseases, Medical Research and Education Center

Russian Federation, Moscow

A. G. Plisyk

Lomonosov Moscow State University

Email: apl.cardio@yandex.ru

Ph.D. (Med.), senior researcher, Department of Age-Associated Diseases, Medical Research and Education Center; Associate Professor of the Department of Therapy, Faculty of Fundamental Medicine

Russian Federation, Moscow

L. M. Samokhodskaya

Lomonosov Moscow State University

Email: SLM@fbm.msu.ru

PhD, Senior Lecturer, Head of the Laboratory Diagnostics Department at Medical Research and Education Center

Russian Federation, Moscow

E. A. Mershina

Lomonosov Moscow State University

Email: elena_mershina@mail.ru

Dr.Sc. (Med), Head of Radiology Department; Researcher, Department of Urology and Andrology, Medical Research and Educational Center; Senior Lecturer, Department of multidisciplinary clinical training, Faculty of Fundamental Medicine

Russian Federation, Moscow

D. A. Ohobotov

Lomonosov Moscow State University

Email: 14072003m@gmail.com

Ph.D. (Med.), Urologist, senior researcher, Scientific Department of Urology and Andrology, Medical Research and Education Center; Senior Lecturer, Andrology and Urology Faculty of Fundamental Medicine

Russian Federation, Moscow

A. A. Strigunov

Lomonosov Moscow State University

Email: an-strigunov@yandex.ru

PhD student at the Department of Urology and Andrology of the Faculty of Fundamental Medicine; Trainee Researcher of the Scientific Department of Urology and Andrology

Russian Federation, Moscow

D. D. Tsurskaya

Lomonosov Moscow State University

Email: dashnom03@gmail.com

Radiologist

Russian Federation, Moscow

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2. Fig. Oriented acyclic factor graph for admission to the ICU or death of male patients with moderate or severe COVID-19

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