ABSTRACT
INTRODUCTION AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic continues to be a global health crisis despite the recent worldwide vaccine distribution. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is most commonly believed to cause severe disease manifestations secondary to a cytokine storm. Low testosterone is associated with a proinflammatory environment and it is thought that a eugonadal testosterone level may be protective of increased cytokine activity. Objective: In this study, we explore the association between baseline testosterone level and COVID-19 clinical outcomes. METHODS: Through a retrospective chart review, we identified 188 males from an academic health system in a metropolitan area diagnosed with COVID-19 with measured baseline testosterone levels who were not on testosterone replacement therapy. The 188 males were divided into eugonadal (n=90, >300 ng/dL) and hypogonadal (n=98, ≤300 ng/dL) testosterone groups. Data regarding comorbidities and endpoints such as hospital admission, intensive care unit admission, ventilator utilization, and thromboembolic events were extracted. Chi-square and Fisher's Exact tests examined differences in categorical variables. Logistic regression analysis tested the relationship between testosterone level and endpoints. RESULTS: There were 188 men identified who met our inclusion criteria. There were 90 men in the eugonadal group and 98 men in the hypogonadal group. Median age (IQR) was 55 (43-67) for the eugonadal group and 55 (40-63) for the hypogonadal group, median BMI was 30.6 (27.7-35.4) and 31.3 (26.4-35.6), and median testosterone level was 396 (357-476.3 ng/dL) and 217 (141.3 - 255 ng/dL) for the two groups respectively. Hypogonadism was significantly related to hospital admission (p=0.027). While not statistically significant, there were more ICU admissions (p=0.75), ventilator use (p=0.75), and DVTs seen in the hypogonadal group. On logistic regression analysis, hypogonadism was predictive of hospital admission (p=0.021). CONCLUSIONS: Eugonadal testosterone level may be protective of more severe clinical outcomes in COVID-19. Hypogonadism is associated with increased hospital admission. Further research with a larger sample size needs to be conducted to fully understand the relationship between testosterone and clinical outcomes in COVID-19.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Continued vigilance of operative outcomes of COVID-19 patients is important given the relative novelty of the SARS-CoV-2 infection. We here sought to evaluate the 30-day mortality and cardiopulmonary adverse event rates in patients undergoing emergency surgery with perioperative COVID-19 infection, in comparison to a control group of medically managed COVID-19 patients that did not require surgical intervention. METHODS: A retrospective review of electronic medical data from a single tertiary-care center in Michigan was undertaken. Patients who had tested positive for SARS-CoV-2 infection either 7 days before or within 30 days after surgery during March-May 2020 were included in the study (n=52). Propensity score matched (1:6) patients who had been positive for SARS-CoV-2 infection during this time-period but did not undergo surgery were used as controls (n=314, Figure 1). The primary endpoint was 30-day mortality. Secondary endpoints included cardiac and pulmonary complications. Multivariable logistic regression analyses were utilized to account for baseline differences. A pvalue <0.05 was considered significant. RESULTS: The 30-day mortality (17.3% vs 13.1%, p=0.408) and cardiac (28.9% vs 19.1%, p=0.107) and pulmonary complication (55.8% vs 49.4%, p=0.392) rates were similar in patients in the surgical versus non-surgical group, respectively. Multivariable analyses confirmed that an emergency surgical intervention was not associated with increased odds for any of the studied adverse events (p >0.10 for all 3 endpoints). CONCLUSIONS: Patients undergoing emergency surgery with a co-diagnosis of SARS-CoV-2 infection in the perioperative period do not have an increased risk for short-term mortality or cardiopulmonary complications compared to the medically treated COVID-19 patients.