tetano
Editor, Senior Moderator
Int J Endocrinol
. 2022 Feb 25;2022:4280691.
doi: 10.1155/2022/4280691. eCollection 2022.
Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study
Iraj Ahmadi[SUP] 1 2 [/SUP], Hamideh Estabraghnia Babaki[SUP] 3 [/SUP], Maryam Maleki[SUP] 1 [/SUP], Hashem Jarineshin[SUP] 3 [/SUP], Mohammad Reza Kaffashian[SUP] 1 [/SUP], Mehdi Hassaniazad[SUP] 4 [/SUP], Azra Kenarkoohi[SUP] 5 [/SUP], Amin Ghanbarnejad[SUP] 6 [/SUP], Shahab Falahi[SUP] 7 [/SUP], Mitra Kazemi Jahromi[SUP] 8 [/SUP], Hori Ghaneialvar[SUP] 9 [/SUP], Shahla Sohrabipour[SUP] 8 [/SUP]
Affiliations
Abstract
There is some indication that coronavirus disease 2019 (COVID-19) causes hypothalamic-pituitary-adrenal axis insufficiency. However, being on glucocorticoids makes it difficult to fully investigate this axis, especially in patients with severe COVID-19. We aimed to discover if there was a connection between blood total cortisol and adrenocorticotropic hormone (ACTH) levels and mortality in patients with COVID-19. In Iran, 154 hospitalized patients with COVID-19 were studied in a prospective cohort study. ACTH and cortisol levels in the blood were measured on the first or second day of hospitalization. Most patients (52.6 vs. 47.4%) were men over 50 years old (55.8%), and 44.4% had an underlying illness. Serum cortisol and plasma ACTH medians were 15.6 (μg/dl) and 11.4 (pg/ml), respectively. 9.09% of the patients died. Cortisol levels were substantially lower in those who died (11.3 μg/dl) than in patients who were discharged (16.7 μg/dl, P < 0.01), while ACTH levels were unaffected. The most important factors determining mortality, according to the logistic model, were blood cortisol levels, the existence of an underlying disease, and the use of a mechanical ventilator. Cortisol levels that rose by one-unit correlated with a 26% lower risk of mortality. Comorbidities and mechanical ventilation increased the risk of death by 260 and 92 times, respectively. It can be concluded that in patients with COVID-19, a low cortisol level is linked to a high risk of mortality. Patients may sometimes have relative primary adrenal insufficiency. To judge and decide on therapeutic interventions, more reliable and long-term follow-up studies are required.
. 2022 Feb 25;2022:4280691.
doi: 10.1155/2022/4280691. eCollection 2022.
Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study
Iraj Ahmadi[SUP] 1 2 [/SUP], Hamideh Estabraghnia Babaki[SUP] 3 [/SUP], Maryam Maleki[SUP] 1 [/SUP], Hashem Jarineshin[SUP] 3 [/SUP], Mohammad Reza Kaffashian[SUP] 1 [/SUP], Mehdi Hassaniazad[SUP] 4 [/SUP], Azra Kenarkoohi[SUP] 5 [/SUP], Amin Ghanbarnejad[SUP] 6 [/SUP], Shahab Falahi[SUP] 7 [/SUP], Mitra Kazemi Jahromi[SUP] 8 [/SUP], Hori Ghaneialvar[SUP] 9 [/SUP], Shahla Sohrabipour[SUP] 8 [/SUP]
Affiliations
- PMID: 35251166
- PMCID: PMC8896943
- DOI: 10.1155/2022/4280691
Abstract
There is some indication that coronavirus disease 2019 (COVID-19) causes hypothalamic-pituitary-adrenal axis insufficiency. However, being on glucocorticoids makes it difficult to fully investigate this axis, especially in patients with severe COVID-19. We aimed to discover if there was a connection between blood total cortisol and adrenocorticotropic hormone (ACTH) levels and mortality in patients with COVID-19. In Iran, 154 hospitalized patients with COVID-19 were studied in a prospective cohort study. ACTH and cortisol levels in the blood were measured on the first or second day of hospitalization. Most patients (52.6 vs. 47.4%) were men over 50 years old (55.8%), and 44.4% had an underlying illness. Serum cortisol and plasma ACTH medians were 15.6 (μg/dl) and 11.4 (pg/ml), respectively. 9.09% of the patients died. Cortisol levels were substantially lower in those who died (11.3 μg/dl) than in patients who were discharged (16.7 μg/dl, P < 0.01), while ACTH levels were unaffected. The most important factors determining mortality, according to the logistic model, were blood cortisol levels, the existence of an underlying disease, and the use of a mechanical ventilator. Cortisol levels that rose by one-unit correlated with a 26% lower risk of mortality. Comorbidities and mechanical ventilation increased the risk of death by 260 and 92 times, respectively. It can be concluded that in patients with COVID-19, a low cortisol level is linked to a high risk of mortality. Patients may sometimes have relative primary adrenal insufficiency. To judge and decide on therapeutic interventions, more reliable and long-term follow-up studies are required.