High levels of stress hormone found in patients with severe Covid-19

A high level of the stress hormone cortisol has been found in patients with severe Covid-19 according to a new study.

Professor Waljit Dhillo, NIHR Researcher, a Consultant Endocrinologist at Imperial College Healthcare NHS Trust and Professor of Endocrinology and Metabolism at Imperial College London led the study which provides the first data showing cortisol levels being a marker of the severity of the illness.

By measuring cortisol levels suggests that doctors could intervene more quickly by identifying those patients who are more likely to need intensive care.

According to Imperial College Healthcare Trust:

‘Cortisol is a hormone 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.

‘Our cortisol levels when healthy and resting are 100-200 nm/L and nearly zero when we sleep.

‘Low levels of cortisol can be life threatening in unwell patients but excessive levels of cortisol during illness can be equally dangerous, leading to increased risk of infection and poor outcomes.’

Talking about the study itself, the trust said:

‘In this new observational study of 535 patients, of whom 403 were confirmed to have COVID-19, cortisol levels in patients with COVID-19 were significantly 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 longer than patients with levels over 744.’

Professor Dhillo 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 study has been published in The Lancet Diabetes & Endocrinology journal and is funded by the National Institute for Health Research (NIHR) and the Medical Research Council.

The study involved 535 patients with suspected Covid-19 admitted to three hospitals between 9th March and 22nd April 2020; Charing Cross, Hammersmith and St Mary’s.