PURPOSE: Most critically ill male patients have reduced serum testosterone levels during their illness. Hypotestosteronemia has been reported in 24-96% of patients with trauma, sepsis, shock, and cardiac disease. Acute respiratory failure accounts for a large proportion of patients in a medical ICU (MICU). It is unknown if this population has hypotestosteronemia and how it affects their respiratory outcomes. This study aims to determine the incidence of hypotestosteronemia in mechanically ventilated male patients and their duration of intubation and length of stay in the MICU.
METHODS: Eligible mechanically ventilated male patients underwent laboratory analysis for serum hormone levels by enzyme immunoassay (EIA) on day 1 (admission) and day 3 (if still on mechanical ventilation). Pertinent clinical information was obtained from the patients’ medical record. Outcomes data such as days on mechanical ventilation, length of ICU stay, and survival were collected for all patients.
RESULTS: 15 patients were enrolled in the study with an average age of 58+23 years (Mean+SD) and APACHE II score of 22.6+6.9. Mean total testosterone level (normal: 240-827 ng/dl) on day 1 was 127+105 and on Day 3 was 99+75. Mean free testosterone level (normal: 47-244 pg/ml) on Day 1 was 27+25 and on Day 3 was 22+12. More than 85% of patients had a total and free testosterone level below normal. Average duration of mechanical ventilation was 7.3 days, length of ICU stay was 10.7 days and mortality was 27%.
CONCLUSION: Most mechanically ventilated male patients have hypotestosteronemia with decreasing trends over time.
CLINICAL IMPLICATIONS: Mechanically ventilated male patients have hypotestosteronemia with a decrease in total and free testosterone levels from day 1 to day 3. These may affect their duration of intubation and length of ICU stay. Future studies need to correlate serum testosterone levels with disease severity, short and long-term outcomes, and survival. It is conceivable that replacement therapy with testosterone or its analogue may attenuate the effects of critical illness and improve outcomes.
DISCLOSURE: Aditya Gupta, No Financial Disclosure Information; No Product/Research Disclosure Information