The prognostic value of androgenetic alopecia and benign prostatic hyperplasia in men with COVID-19: a prospective multidisciplinaryobservational study of 766 patients from Turkey

Year 2022, Volume: 5 Issue: 6, 1518 - 1528, 25.10.2022

Çağrı Turan , Nurcan Metin , Türkantuğba Yıldız , Selcen Caferoğlu Skat , Ahmet Cinislioğlu , Nazan Cinislioğlu

https://doi.org/10.32322/jhsm.1131546

Abstract

Objectives: We aimed to investigate the prognostic value of androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH) in COVID-19.
Material and Method: This prospective study was conducted only on men with COVID-19. All patients were recruited consecutively from the COVID-19 emergency service. 766 patients were evaluated in three independent groups between the ages of 30-49 (young), 50-64 (middle-aged), and 65-75 (elderly) to avoid Simson’s paradox. Age, body mass index, smoking, comorbidities, vital signs, oxygen saturation (SpO2%), laboratory (CRP, lymphocyte count, ferritin, d-dimer) and computed tomography (CT) results, hospitalization (primary endpoint), transfer to intensive care unit (ICU), AGA stage (Hamilton-Norwood scale, 3-7=moderate-severe AGA, Gabrin sign) and BPH were recorded.
Results: There was no relationship with AGA in any prognostic parameter in the young age group. There was a significant difference in the poor prognostic direction in patients with Gabrin sign, in SpO2 and lymphocyte count for middle-aged, and CRP for the elderly (p=0.141, p=0.013, p=0.029; respectively). The frequencies of transfer to the ICU were higher with no statistical significance in patients with the Gabrin sign. The mortality was more common with no statistical significance in elderly patients with the Gabrin sign. Hospitalization frequencies were significantly higher in patients with BPH in middle-aged and elderly patients (p=0.041, p=0.026; respectively). No relationship was found between transfer to ICU, mortality, and BPH.
Conclusions: AGA was not a prognostic indicator, though the increase in hospitalization frequency, particularly in elderly patients with BPH, may be associated with the androgen-mediated COVID-19 severity hypothesis.

Keywords

Androgenetic alopecia, Gabrin sign, benign prostatic hypertrophy, COVID-19, prognosis, hospitalization

References

• Guan WJ, Ni ZY, Hu Y, et al. China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20.
• Jin JM, Bai P, He W, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health 2020; 8: 152.
• vom Steeg LG, Klein SL. SeXX Matters in Infectious Disease Pathogenesis. PLoS Pathog 2016; 12: e1005374.
• Wambier CG, Goren A. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is likely to be androgen mediated. J Am Acad Dermatol 2020; 83: 308-9.
• Wambier CG, Vaño-Galván S, McCoy J, Pai S, Dhurat R, Goren A. Androgenetic alopecia in COVID-19: compared to age-matched epidemiologic studies and hospital outcomes with or without the Gabrin sign. J Am Acad Dermatol 2020; 83: e453-4.
• Nielsen HC, Zinman HM, Torday JS. Dihydrotestosterone inhibits fetal rabbit pulmonary surfactant production. J Clin Invest 1982; 69: 611-16.
• Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181: 271-80
• Lucas JM, Heinlein C, Kim T, et al. The androgen-regulated protease TMPRSS2 activates a proteolytic cascade involving components of the tumor microenvironment and promotes prostate cancer metastasis. Cancer Discov 2014; 4: 1310-25.
• Asselta R, Paraboschi E, Mantovani A, Duga S. ACE2 and TMPRSS2 variants and expression as candidates to sex and country differences in COVID-19 severity in Italy. Aging (Albany NY) 2020; 12: 10087-98.
• Wambier CG, Goren A, Vaño-Galván S, et al. Androgen sensitivity gateway to COVID-19 disease severity. Drug Dev Res 2020; 81: 771-76.
• Bennett CL, Price DK, Kim S, et al. Racial variation in CAG repeat lengths within the androgen receptor gene among prostate cancer patients of lower socioeconomic status. J Clin Oncol 2002; 20: 3599-604.
• McCoy J, Wambier CG, Vano-Galvan S, et al. Racial variations in COVID-19 deaths may be due to androgen receptor genetic variants associated with prostate cancer and androgenetic alopecia. Are anti-androgens a potential treatment for COVID-19? J Cosmet Dermatol 2020; 19: 1542-43.
• Montopoli M, Zumerle S, Vettor R, et al. Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532). Ann Oncol 2020; 31: 1040-45.
• Severe COVID-19 GWAS Group, Ellinghaus D, Degenhardt F, et al. Genomewide association study of severe COVID-19 with respiratory failure. N Engl J Med 2020; 383: 1522-34.
• Lai J-J, Chang P, Lai K-P, Chen L, Chang C. The role of androgen and androgen receptor in skin-related disorders. Arch Dermatologic Res 2012; 304: 499-510.
• Bhowmick NA, Oft J, Dorff T, et al. COVID-19 and androgen-targeted therapy for prostate cancer patients. Endocr Relat Cancer 2020; 27: R281-R92.
• Republic of Turkey Ministry of Health, General Directorate of PublicHealth. COVID-19 (SARS-CoV2 Infection) Guide (Coronavirus Science Board Study): 2020. Available at: https://covid19.saglik.gov.tr/Eklenti/39061/0/covid-19rehberieriskinhastatedavisipdf.pdf. Published (June 4, 2020). Updated (September 17, 2020). Accessed (February 28, 2021).
• Sarıkaya K, Senocak C, Sadioglu FE, Bozkurt ÖF. Is combined topical-local anesthesia technique adequate for visual internal urethrotomy in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses? Ulus J Trauma Emerg Surg 2021; 27: 139-45.
• Wang B, Wu P, Kwan B, Tu XM, Feng C. Simpson’s Paradox: Examples. Shanghai Arch Psychiatry 2018; 30: 139-43.
• Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149-60.
• Lenhard W, Lenhard A. Calculation of Effect Sizes. 2016 Available at: https://www.psychometrica.de/effect_size.html. Dettelbach (Germany): Psychometrica.Accessed (28 February 2021).
• Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141: 2-18.
• Monib KME, Hussein MS, Kandeel WS. The relation between androgenetic thin hair diagnosed by trichoscope and benign prostatic hyperplasia. J Cosmet Dermatol 2019; 18: 1502-6.
• Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020; 81: e16-e25.
• Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020; 58: 1021-28.
• Zeng F, Huang Y, Guo Y, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. Int J Infect Dis 2020; 96: 467-74.
• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-62. Erratum in: Lancet 2020; 395: 1038.
• Wambier CG, Vaño-Galván S, McCoy J, et al. Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: The “Gabrin sign”. J Am Acad Dermatol 2020; 83: 680-2.
• Severi G, Sinclair R, Hopper JL, et al. Androgenetic alopecia in men aged 40-69 years: prevalence and risk factors. Br J Dermatol 2003; 149: 1207-13.
• Goren A, Vaño-Galván S, Wambier CG, et al. A preliminary observation: Male pattern hair loss among hospitalized COVID-19 patients in Spain - A potential clue to the role of androgens in COVID-19 severity. J Cosmet Dermatol 2020; 19: 1545-47.
• Karabulut I, Cinislioglu AE, Cinislioglu N, et al. The effect of the presence of lower urinary system symptoms on the prognosis of COVID-19: preliminary results of a prospective study. Urol Int 2020; 104: 853-58.
• Topaktaş R, Tokuç E, Ali Kutluhan M, Akyüz M, Karabay E, Çalışkan S. Clinical features and outcomes of COVID-19 patients with benign prostatic hyperplasia in ageing male: A retrospective study of 18 cases. Int J Clin Pract 2020; 74: e13574.