Cortisol, which is known as the stress hormone, puts individuals who have been tested positive for coronavirus disease at higher risk of death.
COVID-19 patients with a high cortisol level are in danger of declining very fast and dying, a study has found.
It also suggests that cortisol levels in the blood can signal how severe the illness is and so it can be a useful marker to single out those patients in need of critical care.
When we are under stress our body produces cortisol: a steroid hormone to help us deal with the problem.
Cortisol levels would rise with issues like changes in metabolism, high blood pressure, heart disease, illnesses, and immune response.
The highest levels of cortisol in healthy people occur naturally in the morning and the lowest at night during sleep.
In healthy situations or while resting, serum cortisol concentration is from 100 to 200 nmol/L and when we sleep the levels go down to almost zero.
Low or high cortisol levels are similarly dangerous and potentially fatal as they can damage the immune system seriously and increase the risk of all sorts of infections.
The study found that cortisol levels in a group of patients with COVID-19 were considerably higher compared to the patient group without COVID-19.
The cortisol stress responses in the patients with COVID-19 reached a range up to 3,241 nmol/L.
This was much higher even than patients who undergo major surgery, when generally levels stay below 1,000 nmol/L.
The average survival for those COVID-19 patients with cortisol concentration of 744 nmol/L or less was 36 days and it got worse for those with cortisol values over 744 nmol/L as they only lived for an average of 15 days.
Professor Waljit Dhillo, the study’s lead author, 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 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.
In addition, we can also take cortisol levels into account when we are working out how best to treat our patients.”
The death rate throughout the study period for patients in the COVID-19 group was 27.8 percent whereas the rate for the non-COVID group was 6.8 percent.
The study was published in The Lancet Diabetes & Endocrinology (Tan et al., 2020).