COVID-19 patients with high cortisol are at greater risk of death

COVID-19 patients with very high levels of the stress hormone cortisol in their blood are more likely to deteriorate quickly and die.

The study, led by NIHR Research Professor Waljit Dhillo from Imperial College London and Consultant Endocrinologist at Imperial College Healthcare NHS Trust, suggests that COVID-19 patients with very high levels of the stress hormone cortisol in their blood are more likely to deteriorate quickly and die.

This is good the first time; the Sochi has shown that cortisol levels are a marker of the severity of the illness. Scientists cautioned that they could be used to identify those patients who are more likely to need intensive care.

Our cortisol levels when healthy and resting are 100-200 nm/L and nearly zero when we sleep.

In the new observational study of 535 patients, of whom 403 were confirmed to have COVID-19, cortisol levels in patients with COVID-19 were significantly higher than in those without. The levels in the COVID-19 group ranged as high as 3241 – considerably higher even than after significant surgery when levels can top 1000.

Amongst the COVID-19 patients, those with a baseline cortisol level of 744 or less survived on average for 36 days. Patients with levels over 744 had an average survival of just 15 days.

Professor Dhillo, Head of Division of Diabetes, Endocrinology, and Metabolism at Imperial College London said: “From an endocrinologist’s perspective, it makes sense that those COVID-19 patients who are the sickest will have higher levels of cortisol, but these levels are worryingly high.”

“Three months ago, when we started seeing this wave of COVID-19 patients here in London hospitals, we had very little information about how to best triage people. Now, when people arrive at the hospital, we potentially have another simple marker to use alongside oxygen saturation levels to help us identify which patients need to be admitted immediately, and which may not.”

“Having an early indicator of which patients may deteriorate more quickly will help us with providing the best level of care as quickly as possible, as well as helping manage the pressure on the NHS. Also, we can also take cortisol levels into account when we are working out how best to treat our patients.”

Journal Reference:
  1. Tricia Tan et al. Association between high serum total cortisol concentrations and mortality from COVID-19. DOI: 10.1016/S2213-8587(20)30216-3

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