COVID-19 patients with extremely high levels of cortisol are more likely to deteriorate quickly and die, according to new research published in Lancet Diabetes and Endocrinology.
The study, led by National Institute for Health Research (NIHR) Research Professor Waljit Dhillo from Imperial College London and Consultant Endocrinologist at Imperial College Healthcare NHS Trust, provides the first data to show that cortisol levels are a marker of COVID-19 severity of the illness. The researchers suggest cortisol levels could be used to identify patients who are more likely to need intensive care.
The analysis included 621 patients admitted to three large teaching hospitals in London between 9 March 2020 and 22 April 2020, with a clinical suspicion of COVID-19 who had at least one cortisol measurement during their admission.
After exclusions, 535 patients with cortisol measurements were available for analysis, of whom 403 were diagnosed with COVID-19 (mean age, 66.3 years).
The most frequent comorbidities in patients with COVID-19 were hypertension (47.4%), diabetes (39.7%), cardiovascular disease (23.3%), chronic kidney disease (12.4%) and a current diagnosis of cancer (9.4%).
Median cortisol concentration in the group of patients with COVID-19 was 619 nmol/L versus 519 nmol/L in the patient group who did not have COVID-19 (P<.0001>
Amongst the COVID-19 patients, those with a baseline cortisol level of ≤744 nmol/L survived on an average for 36 days. Patients with levels >744 nmol/L had an average survival of just 15 days.
In this cohort, cortisol seemed to be a better independent predictor than other laboratory markers associated with COVID-19, such as C-reactive protein, D-dimer and neutrophil to leukocyte ratio.