Julie Goswami, MD
Clinical Instructor
Mayo Clinic College of Medicine, United States
Disclosure information not submitted.
Tammy Price-Troska
Research Technologist
Mayo Clinic, Rochester, United States
Disclosure information not submitted.
Kaitlin Lundell, B.S.
Research Coordinator
Mayo Clinic, Rochester, United States
Disclosure information not submitted.
Beth Ballinger, MD
Assistant Professor of Surgery
Mayo Clinic, United States
Disclosure information not submitted.
Erica Loomis, MD
Assistant Professor of Surgery
Mayo Clinic, United States
Disclosure information not submitted.
Stephanie Heller, M.D.
Associate Professor of Surgery
Mayo Clinic Rochester, United States
Disclosure information not submitted.
Daniel Stephens, M.D.
Assistant Professor of Surgery
Mayo Clinic, Rochester, United States
Disclosure information not submitted.
Grant Spears, B.S.
Statistical Programmer
Mayo Clinic, Rochester, United States
Disclosure information not submitted.
Kent Bailey, Ph.D
Professor of Biostatistics
Mayo Clinic, Rochester, United States
Disclosure information not submitted.
Irshad Chaudry, M.D.
Professor of Surgery
University of Alabama at Birmingham, United States
Disclosure information not submitted.
Title: Estradiol and Dihydrotestosterone Levels in COVID-19 Patients
Introduction: Sex hormones impact viral cell entry, immune response, and outcomes in trauma and sepsis. The SARs-CoV-2 virus (COVID-19) utilizes the ACE-2 receptor for cell entry. ACE-2 expression is downregulated by 17β-Estradiol. The objective of this study was to identify dimorphisms in plasma sex hormones in COVID-19 patients compared to a reference population of healthy volunteers (HVs).
Methods: In an IRB approved study, citrated plasma samples were collected from 101 consented COVID-19 positive patients and 40 previously enrolled HVs. Plasma 17β-Estradiol and dihydrotestosterone (DHT) levels were measured using ELISA. Clinical data were tracked through the electronic medical record. Data presented as median and interquartile range [IQR]. Wilcoxon rank sum test, p < 0.05 significant.
Results: COVID-19 positive patients (median age 49 years) included 51 males and 50 females, (25 post-menopausal). Of male patients, 59% required hospital admission, while 48% of female patients (16 post-menopausal) required admission. HVs (median age 40.5 years) included 20 males and 20 females (9 post-menopausal). Female COVID-19 patients were found to have decreased 17β-Estradiol levels (18.4 pg/mL [10.5, 32.3]; 41.4 [15.5, 111.0], p = 0.025), no difference in DHT levels (232.0 [123.4, 407.9]; 224.5 pg/mL [129.9, 385.5], p = 0.648), and lower 17β-Estradiol to DHT ratios (0.073 [0.051, 0.169]; 0.207 [0.104, 0.538], p = 0.041) than female HVs . Male COVID-19 patents were found to have no difference in 17β-Estradiol levels (19.1 pg/mL [14.5, 21.6]; 18.1 pg/mL [13.5, 27.8], p = 0.798), decreased DHT levels (302.8 pg/mL [249.9, 470.8]; 457.2 pg/mL [368.7, 844.3], p = 0.005), and no difference in 17β-Estradiol to DHT ratios (0.056 [0.040, 0.078]; 0.037 [0.023, 0.072], p = 0.120), compared to male HVs. There was no difference in 17β-Estradiol (19.1 pg/mL [14.5, 25.4]; 18.4 pg/mL [10.5, 26.3], p = 0.414) or DHT levels (294.1 pg/mL [142.2, 427.0]; 281.3 pg/mL [176.9, 489.9, p = 0.844) for admitted COVID-19 patients as compared to those who were not admitted.
Conclusions: Sex hormone levels differ between COVID-19 patients and HVs, with discrete patterns in males and females. Given the regulation of ACE-2 expression by 17β-Estradiol, these alterations may be associated with disease development and severity.