PB0054 - Impact of variations in sex hormone levels on the hypercoagulability and severity of COVID-19 in women and men according to age. The ROADMAP-COVID-19 study

Background: COVID-19 has been associated with hypercoagulability, endothelial cell injury and frequent thrombotic complications. Evidence show that men and older patients are at higher risk of disease worsening as compared to women.

Aims: To study the impact of hormonal and age variations in women and men on the risk of COVID-19 worsening.

Methods: 201 patients with symptomatic newly diagnosed COVID-19 (older than 18 years) were enrolled in the study. Participants were divided into two groups according to COVID-19 severity (moderate and severe), subdivided according to the sex and age (under or over 50 years). Biomarkers of hypercoagulability and endothelial cell activation and the levels of total testosterone, oestradiol, progesterone and aromatase were measured.

Results: The levels of biomarkers of hypercoagulability and endothelial cell activation and hormone variations in patients and controls according to age and gender are reported in Table 1. Testosterone levels were significatively decreased in men independently of the age. The oestradiol levels were within the normal range in women but significantly increased in men. Aromatase levels increased in both sexes but significantly more in men older than 50 years. Testosterone levels were significantly decreased, and oestradiol levels were significantly increased in men with severe COVID-19. Men with severe COVID-19 had a lower progesterone level. No statistically significant difference in testosterone or progesterone levels were found in the women, (Table 2.) A correlation was found between the diminution of testosterone and the endothelial cell activation in men independently of the age.

Conclusion(s): The ROADMAP-COVID-19 study identified that in men, the decrease of testosterone and the increase of oestrogens are associated with the risk of severe COVID-19. Monitoring of sex hormones might be an additional tool for the identification of patients at risk of COVID-19 worsening.