Patients With COVID-19 Mount Acute Cortisol Stress Response
High cortisol concentrations associated with increased mortality, reduced median survival
WEDNESDAY, June 24, 2020 (HealthDay News) -- Patients with COVID-19 mount a marked and appropriate acute cortisol stress response, according to a research letter published online June 19 in The Lancet Diabetes & Endocrinology.
Noting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could theoretically amplify morbidity and mortality by inducing a cortisol insufficiency related to critical illness, Tricia Tan, M.D., from Imperial College London, and colleagues conducted a cohort study to examine whether this process might contribute to the pathophysiology of COVID-19. A cohort of 535 patients with cortisol measurements were included; of these, 403 were diagnosed with COVID-19 and 132 were not.
The researchers found that during the study, 27.8 percent of patients with COVID-19 and 6.8 percent of those without COVID-19 died. Median cortisol concentrations were 619 and 519 nmol/L in patients with and without COVID-19, respectively. In a multivariable analysis, after adjustment for age, comorbidities, and laboratory tests, a doubling of cortisol concentration was associated with a significant 42 percent increase in the risk for mortality. Median survival was 36 and 15 days for patients with COVID-19 whose baseline cortisol concentration was ≤744 nmol/L and >744 nmol/L, respectively.
"Our cohort did not obviously exhibit an adrenal insufficiency with SARS-CoV-2 infection in the acute setting," the authors write. "We found that high cortisol concentrations were associated with increased mortality and a reduced median survival, probably because this is a marker of the severity of illness."