Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19
Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition. To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated b...
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| creator | Dhindsa, Sandeep Zhang, Nan McPhaul, Michael J Wu, Zengru Ghoshal, Amit K Erlich, Emma C Mani, Kartik Randolph, Gwendalyn J Edwards, John R Mudd, Philip A Diwan, Abhinav |
| description | Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition.
To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated by sex hormone signaling) with COVID-19 severity.
This prospective cohort study was conducted using serum samples collected from consecutive patients who presented from March through May 2020 to the Barnes Jewish Hospital in St Louis, Missouri, with COVID-19 (diagnosed using nasopharyngeal swabs).
Testosterone, estradiol, and IGF-1 concentrations were measured at the time of presentation (ie, day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized).
Baseline hormone concentrations were compared among patients who had severe COVID-19 vs those with milder COVID-19 illness. RNA sequencing was performed on circulating mononuclear cells to understand the mechanistic association of altered circulating hormone concentrations with cellular signaling pathways.
Among 152 patients (90 [59.2%] men; 62 [40.8%] women; mean [SD] age, 63 [16] years), 143 patients (94.1%) were hospitalized. Among 66 men with severe COVID-19, median [interquartile range] testosterone concentrations were lower at day 0 (53 [18 to 114] ng/dL vs 151 [95 to 217] ng/dL; P = .01) and day 3 (19 [6 to 68] ng/dL vs 111 [49 to 274] ng/dL; P = .006) compared with 24 men with milder disease. Testosterone concentrations were inversely associated with concentrations of interleukin 6 (β = -0.43; 95% CI, -0.52 to -0.17; P |
| doi_str_mv | 10.1001/jamanetworkopen.2021.11398 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8150664</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2532249654</sourcerecordid><originalsourceid>FETCH-LOGICAL-a473t-741ee51f14d07894a6147757547012bb901005cfbec174ee1c84f22f9f2e52b03</originalsourceid><addsrcrecordid>eNpdkU9P3DAQxa2qqCDgK1RWe-kli__GSQ-V0ELLSkgg0cLRcrJj1tvEXuwEyrevl10QcPJY83ujmfcQ-kLJhBJCj5amNx6GhxD_hhX4CSOMTijldfUB7TGpRMErIj--qnfRYUpLQggjGSvlJ7TLBeGsknwPLY5TCq0zgwseB4unLrZjl7_-Fl_BP3wWYh88JHzjhgWeeduZvt_Qxs_xiUtgEmT0HqIbHrHz-DK3wQ9byfTienZS0PoA7VjTJTjcvvvoz8_T39Oz4vzi12x6fF4YofhQKEEBJLVUzImqamFKKpSSSgpFKGuammQXZGsbaKkSALSthGXM1paBZA3h--jHZu5qbHqYt3mTaDq9iq438VEH4_TbjncLfRvudUUlKUuRB3zbDojhboQ06N6lFrou2x7GpJnkjIns4xr9-g5dhjH6fJ5mZakqTnipMvV9Q7UxpBTBvixDiV5nqt9lqteZ6qdMs_jz63NepM8J8v-EKaIt</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2667830367</pqid></control><display><type>article</type><title>Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Dhindsa, Sandeep ; Zhang, Nan ; McPhaul, Michael J ; Wu, Zengru ; Ghoshal, Amit K ; Erlich, Emma C ; Mani, Kartik ; Randolph, Gwendalyn J ; Edwards, John R ; Mudd, Philip A ; Diwan, Abhinav</creator><creatorcontrib>Dhindsa, Sandeep ; Zhang, Nan ; McPhaul, Michael J ; Wu, Zengru ; Ghoshal, Amit K ; Erlich, Emma C ; Mani, Kartik ; Randolph, Gwendalyn J ; Edwards, John R ; Mudd, Philip A ; Diwan, Abhinav</creatorcontrib><description>Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition.
To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated by sex hormone signaling) with COVID-19 severity.
This prospective cohort study was conducted using serum samples collected from consecutive patients who presented from March through May 2020 to the Barnes Jewish Hospital in St Louis, Missouri, with COVID-19 (diagnosed using nasopharyngeal swabs).
Testosterone, estradiol, and IGF-1 concentrations were measured at the time of presentation (ie, day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized).
Baseline hormone concentrations were compared among patients who had severe COVID-19 vs those with milder COVID-19 illness. RNA sequencing was performed on circulating mononuclear cells to understand the mechanistic association of altered circulating hormone concentrations with cellular signaling pathways.
Among 152 patients (90 [59.2%] men; 62 [40.8%] women; mean [SD] age, 63 [16] years), 143 patients (94.1%) were hospitalized. Among 66 men with severe COVID-19, median [interquartile range] testosterone concentrations were lower at day 0 (53 [18 to 114] ng/dL vs 151 [95 to 217] ng/dL; P = .01) and day 3 (19 [6 to 68] ng/dL vs 111 [49 to 274] ng/dL; P = .006) compared with 24 men with milder disease. Testosterone concentrations were inversely associated with concentrations of interleukin 6 (β = -0.43; 95% CI, -0.52 to -0.17; P < .001), C-reactive protein (β = -0.38; 95% CI, -0.78 to -0.16; P = .004), interleukin 1 receptor antagonist (β = -0.29; 95% CI, -0.64 to -0.06; P = .02), hepatocyte growth factor (β = -0.46; 95% CI, -0.69 to -0.25; P < .001), and interferon γ-inducible protein 10 (β = -0.32; 95% CI, -0.62 to -0.10; P = .007). Estradiol and IGF-1 concentrations were not associated with COVID-19 severity in men. Testosterone, estradiol, and IGF-1 concentrations were similar in women with and without severe COVID-19. Gene set enrichment analysis revealed upregulated hormone signaling pathways in CD14+CD16- (ie, classical) monocytes and CD14-CD16+ (ie, nonclassical) monocytes in male patients with COVID-19 who needed intensive care unit treatment vs those who did not.
In this single-center cohort study of patients with COVID-19, lower testosterone concentrations during hospitalization were associated with increased disease severity and inflammation in men. Hormone signaling pathways in monocytes did not parallel serum hormone concentrations, and further investigation is required to understand their pathophysiologic association with COVID-19.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.11398</identifier><identifier>PMID: 34032853</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Coronaviruses ; COVID-19 ; COVID-19 - blood ; COVID-19 - complications ; COVID-19 - pathology ; Cytokines ; Diabetes and Endocrinology ; Estradiol - blood ; Female ; Gonadal Steroid Hormones - blood ; Growth factors ; Hormones ; Hospitalization ; Hospitals ; Humans ; Inflammation - blood ; Inflammation - etiology ; Insulin-Like Growth Factor I - metabolism ; Male ; Middle Aged ; Missouri ; Online Only ; Original Investigation ; SARS-CoV-2 ; Severity of Illness Index ; Sex Factors ; Testosterone ; Testosterone - blood</subject><ispartof>JAMA network open, 2021-05, Vol.4 (5), p.e2111398-e2111398</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2021 Dhindsa S et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a473t-741ee51f14d07894a6147757547012bb901005cfbec174ee1c84f22f9f2e52b03</citedby><cites>FETCH-LOGICAL-a473t-741ee51f14d07894a6147757547012bb901005cfbec174ee1c84f22f9f2e52b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,861,882,27906,27907</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34032853$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhindsa, Sandeep</creatorcontrib><creatorcontrib>Zhang, Nan</creatorcontrib><creatorcontrib>McPhaul, Michael J</creatorcontrib><creatorcontrib>Wu, Zengru</creatorcontrib><creatorcontrib>Ghoshal, Amit K</creatorcontrib><creatorcontrib>Erlich, Emma C</creatorcontrib><creatorcontrib>Mani, Kartik</creatorcontrib><creatorcontrib>Randolph, Gwendalyn J</creatorcontrib><creatorcontrib>Edwards, John R</creatorcontrib><creatorcontrib>Mudd, Philip A</creatorcontrib><creatorcontrib>Diwan, Abhinav</creatorcontrib><title>Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition.
To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated by sex hormone signaling) with COVID-19 severity.
This prospective cohort study was conducted using serum samples collected from consecutive patients who presented from March through May 2020 to the Barnes Jewish Hospital in St Louis, Missouri, with COVID-19 (diagnosed using nasopharyngeal swabs).
Testosterone, estradiol, and IGF-1 concentrations were measured at the time of presentation (ie, day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized).
Baseline hormone concentrations were compared among patients who had severe COVID-19 vs those with milder COVID-19 illness. RNA sequencing was performed on circulating mononuclear cells to understand the mechanistic association of altered circulating hormone concentrations with cellular signaling pathways.
Among 152 patients (90 [59.2%] men; 62 [40.8%] women; mean [SD] age, 63 [16] years), 143 patients (94.1%) were hospitalized. Among 66 men with severe COVID-19, median [interquartile range] testosterone concentrations were lower at day 0 (53 [18 to 114] ng/dL vs 151 [95 to 217] ng/dL; P = .01) and day 3 (19 [6 to 68] ng/dL vs 111 [49 to 274] ng/dL; P = .006) compared with 24 men with milder disease. Testosterone concentrations were inversely associated with concentrations of interleukin 6 (β = -0.43; 95% CI, -0.52 to -0.17; P < .001), C-reactive protein (β = -0.38; 95% CI, -0.78 to -0.16; P = .004), interleukin 1 receptor antagonist (β = -0.29; 95% CI, -0.64 to -0.06; P = .02), hepatocyte growth factor (β = -0.46; 95% CI, -0.69 to -0.25; P < .001), and interferon γ-inducible protein 10 (β = -0.32; 95% CI, -0.62 to -0.10; P = .007). Estradiol and IGF-1 concentrations were not associated with COVID-19 severity in men. Testosterone, estradiol, and IGF-1 concentrations were similar in women with and without severe COVID-19. Gene set enrichment analysis revealed upregulated hormone signaling pathways in CD14+CD16- (ie, classical) monocytes and CD14-CD16+ (ie, nonclassical) monocytes in male patients with COVID-19 who needed intensive care unit treatment vs those who did not.
In this single-center cohort study of patients with COVID-19, lower testosterone concentrations during hospitalization were associated with increased disease severity and inflammation in men. Hormone signaling pathways in monocytes did not parallel serum hormone concentrations, and further investigation is required to understand their pathophysiologic association with COVID-19.</description><subject>Aged</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - blood</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - pathology</subject><subject>Cytokines</subject><subject>Diabetes and Endocrinology</subject><subject>Estradiol - blood</subject><subject>Female</subject><subject>Gonadal Steroid Hormones - blood</subject><subject>Growth factors</subject><subject>Hormones</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inflammation - blood</subject><subject>Inflammation - etiology</subject><subject>Insulin-Like Growth Factor I - metabolism</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Missouri</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>SARS-CoV-2</subject><subject>Severity of Illness Index</subject><subject>Sex Factors</subject><subject>Testosterone</subject><subject>Testosterone - blood</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkU9P3DAQxa2qqCDgK1RWe-kli__GSQ-V0ELLSkgg0cLRcrJj1tvEXuwEyrevl10QcPJY83ujmfcQ-kLJhBJCj5amNx6GhxD_hhX4CSOMTijldfUB7TGpRMErIj--qnfRYUpLQggjGSvlJ7TLBeGsknwPLY5TCq0zgwseB4unLrZjl7_-Fl_BP3wWYh88JHzjhgWeeduZvt_Qxs_xiUtgEmT0HqIbHrHz-DK3wQ9byfTienZS0PoA7VjTJTjcvvvoz8_T39Oz4vzi12x6fF4YofhQKEEBJLVUzImqamFKKpSSSgpFKGuammQXZGsbaKkSALSthGXM1paBZA3h--jHZu5qbHqYt3mTaDq9iq438VEH4_TbjncLfRvudUUlKUuRB3zbDojhboQ06N6lFrou2x7GpJnkjIns4xr9-g5dhjH6fJ5mZakqTnipMvV9Q7UxpBTBvixDiV5nqt9lqteZ6qdMs_jz63NepM8J8v-EKaIt</recordid><startdate>20210503</startdate><enddate>20210503</enddate><creator>Dhindsa, Sandeep</creator><creator>Zhang, Nan</creator><creator>McPhaul, Michael J</creator><creator>Wu, Zengru</creator><creator>Ghoshal, Amit K</creator><creator>Erlich, Emma C</creator><creator>Mani, Kartik</creator><creator>Randolph, Gwendalyn J</creator><creator>Edwards, John R</creator><creator>Mudd, Philip A</creator><creator>Diwan, Abhinav</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210503</creationdate><title>Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19</title><author>Dhindsa, Sandeep ; Zhang, Nan ; McPhaul, Michael J ; Wu, Zengru ; Ghoshal, Amit K ; Erlich, Emma C ; Mani, Kartik ; Randolph, Gwendalyn J ; Edwards, John R ; Mudd, Philip A ; Diwan, Abhinav</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a473t-741ee51f14d07894a6147757547012bb901005cfbec174ee1c84f22f9f2e52b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - blood</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - pathology</topic><topic>Cytokines</topic><topic>Diabetes and Endocrinology</topic><topic>Estradiol - blood</topic><topic>Female</topic><topic>Gonadal Steroid Hormones - blood</topic><topic>Growth factors</topic><topic>Hormones</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Inflammation - blood</topic><topic>Inflammation - etiology</topic><topic>Insulin-Like Growth Factor I - metabolism</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Missouri</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>SARS-CoV-2</topic><topic>Severity of Illness Index</topic><topic>Sex Factors</topic><topic>Testosterone</topic><topic>Testosterone - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhindsa, Sandeep</creatorcontrib><creatorcontrib>Zhang, Nan</creatorcontrib><creatorcontrib>McPhaul, Michael J</creatorcontrib><creatorcontrib>Wu, Zengru</creatorcontrib><creatorcontrib>Ghoshal, Amit K</creatorcontrib><creatorcontrib>Erlich, Emma C</creatorcontrib><creatorcontrib>Mani, Kartik</creatorcontrib><creatorcontrib>Randolph, Gwendalyn J</creatorcontrib><creatorcontrib>Edwards, John R</creatorcontrib><creatorcontrib>Mudd, Philip A</creatorcontrib><creatorcontrib>Diwan, Abhinav</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhindsa, Sandeep</au><au>Zhang, Nan</au><au>McPhaul, Michael J</au><au>Wu, Zengru</au><au>Ghoshal, Amit K</au><au>Erlich, Emma C</au><au>Mani, Kartik</au><au>Randolph, Gwendalyn J</au><au>Edwards, John R</au><au>Mudd, Philip A</au><au>Diwan, Abhinav</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2021-05-03</date><risdate>2021</risdate><volume>4</volume><issue>5</issue><spage>e2111398</spage><epage>e2111398</epage><pages>e2111398-e2111398</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition.
To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated by sex hormone signaling) with COVID-19 severity.
This prospective cohort study was conducted using serum samples collected from consecutive patients who presented from March through May 2020 to the Barnes Jewish Hospital in St Louis, Missouri, with COVID-19 (diagnosed using nasopharyngeal swabs).
Testosterone, estradiol, and IGF-1 concentrations were measured at the time of presentation (ie, day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized).
Baseline hormone concentrations were compared among patients who had severe COVID-19 vs those with milder COVID-19 illness. RNA sequencing was performed on circulating mononuclear cells to understand the mechanistic association of altered circulating hormone concentrations with cellular signaling pathways.
Among 152 patients (90 [59.2%] men; 62 [40.8%] women; mean [SD] age, 63 [16] years), 143 patients (94.1%) were hospitalized. Among 66 men with severe COVID-19, median [interquartile range] testosterone concentrations were lower at day 0 (53 [18 to 114] ng/dL vs 151 [95 to 217] ng/dL; P = .01) and day 3 (19 [6 to 68] ng/dL vs 111 [49 to 274] ng/dL; P = .006) compared with 24 men with milder disease. Testosterone concentrations were inversely associated with concentrations of interleukin 6 (β = -0.43; 95% CI, -0.52 to -0.17; P < .001), C-reactive protein (β = -0.38; 95% CI, -0.78 to -0.16; P = .004), interleukin 1 receptor antagonist (β = -0.29; 95% CI, -0.64 to -0.06; P = .02), hepatocyte growth factor (β = -0.46; 95% CI, -0.69 to -0.25; P < .001), and interferon γ-inducible protein 10 (β = -0.32; 95% CI, -0.62 to -0.10; P = .007). Estradiol and IGF-1 concentrations were not associated with COVID-19 severity in men. Testosterone, estradiol, and IGF-1 concentrations were similar in women with and without severe COVID-19. Gene set enrichment analysis revealed upregulated hormone signaling pathways in CD14+CD16- (ie, classical) monocytes and CD14-CD16+ (ie, nonclassical) monocytes in male patients with COVID-19 who needed intensive care unit treatment vs those who did not.
In this single-center cohort study of patients with COVID-19, lower testosterone concentrations during hospitalization were associated with increased disease severity and inflammation in men. Hormone signaling pathways in monocytes did not parallel serum hormone concentrations, and further investigation is required to understand their pathophysiologic association with COVID-19.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34032853</pmid><doi>10.1001/jamanetworkopen.2021.11398</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Coronaviruses COVID-19 COVID-19 - blood COVID-19 - complications COVID-19 - pathology Cytokines Diabetes and Endocrinology Estradiol - blood Female Gonadal Steroid Hormones - blood Growth factors Hormones Hospitalization Hospitals Humans Inflammation - blood Inflammation - etiology Insulin-Like Growth Factor I - metabolism Male Middle Aged Missouri Online Only Original Investigation SARS-CoV-2 Severity of Illness Index Sex Factors Testosterone Testosterone - blood |
| title | Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19 |
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