Abstract
Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis. To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. Prospective study developed in a pandemic hospital in the city of Şırnak, Turkey. We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU. The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 μg/dl versus 16.47 μg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio: 1.20; 95% confidence interval: 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 μg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 μg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 μg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001). Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.
Highlights
The new virus infection that first appeared in Wuhan, China, at the end of December 2019 spread to most countries across the world, causing a global pandemic
The mortality rate was 12% among COVID-19-negative patients who were admitted to the intensive care unit (ICU), while it was 30.5% among COVID-19-positive patients
Similar to what was observed in previous studies,[11,12,13] our study showed that male sex, high C-reactive protein (CRP) level and low albumin level were associated with high risk of mortality
Summary
The new virus infection that first appeared in Wuhan, China, at the end of December 2019 spread to most countries across the world, causing a global pandemic. In February 2020, the World Health Organization (WHO) named the virus severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and the associated infectious disease, novel coronavirus 2019 (COVID-19).[1]. Acute stress from critical illness increases serum cortisol levels via activation of the hypothalamic-pituitary-adrenal (HPA) axis.[2,3,4] This is the body’s adaptive survival mechanism. SARS-CoV-2 enters pneumocytes using the host’s angiotensin-converting enzyme 2 (ACE2) receptors This enzyme is found in the arterial and venous endothelial cells of several endocrine organs, including the adrenals.[5,6,7] the HPA axis may be affected during the course of SARS-CoV-2 infection. OBJECTIVES: To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. CONCLUSION: Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU
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