The stress hormone cortisol is produced by the body in response to stress such as illness, triggering changes in metabolism, heart function, and the immune system to help our bodies cope.
The cortisol levels when healthy and resting are 100-200 nm/L and nearly zero when we sleep.
When ill patients have low levels of cortisol, it can be life-threatening.
Excessive levels of cortisol during illness can be equally dangerous, leading to increased risk of infection and poor outcomes.
A recent study from Imperial College London and elsewhere found that COVID-19 patients with extremely high levels of cortisol in their blood are more likely to deteriorate quickly and die.
The study provides the first data to show that cortisol levels are a marker of the severity of the illness.
The researchers suggest they can be used to identify those patients who are more likely to need intensive care.
The study is published in The Lancet Diabetes & Endocrinology. One author is NIHR Research Professor Waljit Dhillo.
In the 535 patients of the study, 403 were confirmed to have COVID-19, cortisol levels in patients with COVID-19 were strongly higher than in those without.
The levels in the COVID-19 group ranged as high as 3241—considerably higher even than after major 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.
The team says 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.
They tested 535 patients admitted to three London hospitals—Charing Cross, Hammersmith and St Mary’s—with suspected COVID-19 between 09 March and 22 April 2020.
A COVID-19 swab test and routine blood tests—including a baseline measurement of cortisol levels—were performed within 48hrs of admission.
Over the study period, just under 27% of the COVID-19 group died during the study period compared to just under 7% of the non-COVID-19 group.
Professor Dhillo and his team hope that their findings can now be validated in a larger-scale clinical study.
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