ABSTRACT
INTRODUCTION AND OBJECTIVE: While primarily associated with prostate cancer pathogenesis, TMPRSS2 has recently been identified as a co-receptor for ACE2, the target protein used by SARSCoV2 for viral entry. This protein is primarily regulated by the androgen receptor, and this mechanism may partly explain the disproportionate burden of disease among males. We hypothesized that the use of androgen modulation therapies (AMT) such as 5-a-reductase inhibitors (5-ARI) and androgen deprivation therapy (ADT) may affect inpatient outcomes among hospitalized men with COVID-19. METHODS: In a single-center retrospective analysis in a large urban hospital system, hospitalized males with laboratory-confirmed diagnosis of COVID-19 and a history of benign prostatic hyperplasia (BPH) and/or prostate cancer was identified from February to June 2020. Men were then stratified by use of specific AMT (ADT or 5- ARI). Baseline patient and hospital characteristics were analyzed using descriptive statistics, and multivariable regression models were used to explore the association of AMT with inpatient mortality, length of hospital stay (LOS), and other ICU outcomes (ICU admission, ICU Length of Stay, Non-Invasive Mechanical Ventilation, Intubation, and ARDS). RESULTS: A total of 396 inpatients were identified, with 130 (32.8%) having prior use of AMT. Of these, a large majority used 5-ARI (n=122, 93.8%). Mean (SD) age of patients was higher for those using AMT (76.5 (10.7) vs. 71.1 (11.8) years;p<0.001). No significant differences were identified in AMT use by race, body mass index, smoking status, or Charlson Comorbidity Index. Despite adjustment for these factors, AMT use was not associated with ICU admission, ventilation status, length of ICU stay, or length of hospital stay. However, a non-significant trend of decreased mortality was identified with the use of AMT (adjusted OR: 0.56;95% CI: 0.29e1.02;p=0.06) (Table 1). CONCLUSIONS: Preliminary analysis suggests that AMT does not appear to improve inpatient outcomes among hospitalized males with COVID-19. The non-significant trend of decreased inpatient mortality, however, may be attributed to insufficient power. Future research with large sample sizes may uncover potential benefits of androgen modulation on COVID19 pathogenesis and outcomes.
ABSTRACT
INTRODUCTION AND OBJECTIVE: While subject to frequent speculation, the actual impact of the COVID-19 pandemic on urologic operative practice is unknown. Understanding the consequences of the pandemic will teach invaluable lessons for future preparedness and provide useful context for individual practices attempting to understand changes in operative volume. We analyzed populationlevel changes in operative practice since the onset of the COVID-19 pandemic to contextualize observations made by individual practices and optimize future responses. METHODS: We used Premier Perspectives Database to investigate changes in operative volume through March 2020. Baseline operative volume for urologic surgery was calculated using data from the preceding 12 months and compared on a total and by procedure basis. Multivariable linear regression was used to identify hospital-level predictors of change in response to the pandemic. Our primary outcome of interest was the change in operative volume in March 2020 relative to baseline. Total operative volume, and volume by procedure and procedure-based groupings were investigated. RESULTS: At baseline, we captured 23,788 urologic procedural encounters per month as compared with 19,071 during March 2020e a 19.9% decrease. Urologic oncology-related cases were relatively preserved as compared to others (average change in March 2020: =1.1% versus -32.2%). Northeastern (b=-5.66, 95% confidence interval [CI]: -10.2 to -1.18, p=.013) and Midwestern hospitals (b=-4.17, 95% CI: -7.89 to -0.45, p=.027;both with South as reference region), and those with an increasing percentage of patients insured by Medicaid (b= -.17 per percentage point, 95% CI: -.33 to -.01, p=.04) experienced a significantly larger decrease in volume. CONCLUSIONS: There was a 20% decline in urologic operative volume in March 2020, compared with baseline, that preferentially affected hospitals serving Medicaid patients, and those in the Northeast and Midwest. In the face of varying mandates on elective surgery, widespread declines in operative volume may also represent hesitancy on behalf of patients to interface with healthcare during the pandemic. Long-term follow-up will be necessary to determine COVID-19's final toll on urology.
ABSTRACT
BACKGROUND: Growing evidence suggests a possible sex disparity in COVID-19 disease related outcomes. OBJECTIVE: To explore the sex disparity in COVID-19 cases and outcomes using New York City (NYC) population level data. SETTING: NYC surveillance data from February 29 to June 12, 2020. PARTICIPANTS: Individuals tested for COVID-19 in metropolitan NYC.Outcome Measurements and Statistical Analysis: Outcomes of interest included rates of COVID-19 case positivity, hospitalization and death. Relative risks and case fatality rates were computed for all outcomes based on sex and were stratified by age groups. RESULTS AND LIMITATIONS: 911,310 individuals were included, of whom 434,273 (47.65%) were male and 477,037 (52.35%) were female. Men represented the majority of positive cases (n=106,275, 51.36%), a majority of hospitalizations (n=29,847, 56.44%), and a majority of deaths (n=13,054, 59.23%). Following population level adjustments for age and sex, testing rates of men and women were equivalent. The majority of positive cases and hospitalizations occurred in men for all age groups except age >75 years, and death was more likely in men of all age groups. Men were at a statistically significant greater relative risk of case positivity, hospitalization, and death across all age groups except those <18 years of age. The most significant difference for case positivity was observed in the 65–74 age group (RR 1.22, 95%CI 1.19–1.24), for hospitalization in the 45–65 age group (RR 1.85, 95% 1.80–1.90), and for death in the 18–44 age group (RR 3.30, 95% CI 2.82–3.87). Case fatality rates were greater for men in all age-matched comparisons to women. Limitations include the use of an evolving surveillance data set and absence of further demographic characteristics such as ethnographic data. CONCLUSION: Men have higher rates of COVID-19 positivity, hospitalization, and death despite greater testing of women;this trend remains after stratification by age. J Drugs Dermatol. 2020;19(10):960-967. doi:10.36849/JDD.2020.5590.