Plasma steroid concentrations reflect acute disease severity and normalise during recovery in people hospitalised with COVID‐19
Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Endocrine systems are disrupted in acute illness, and symptoms reported following coronavirus disease 2019 (COVID-19) are similar to those found with clinical hormone deficiencies. We hypothesised that people with severe acute COVID-19 and with post-COVID symptoms have glucocorticoid and sex hormone deficiencies. DESIGN/PATIENTS: Samples were obtained for analysis from two UK multicentre cohorts during hospitalisation with COVID-19 (International Severe Acute Respiratory Infection Consortium/World Health Organisation [WHO] Clinical Characterization Protocol for Severe Emerging Infections in the UK study), and at follow-up 5 months after hospitalisation (Post-hospitalisation COVID-19 study). MEASUREMENTS: Plasma steroids were quantified by liquid chromatography-mass spectrometry. Steroid concentrations were compared against disease severity (WHO ordinal scale) and validated symptom scores. Data are presented as geometric mean (SD). RESULTS: In the acute cohort (n = 239, 66.5% male), plasma cortisol concentration increased with disease severity (cortisol 753.3 [1.6] vs. 429.2 [1.7] nmol/L in fatal vs. least severe, p < .001). In males, testosterone concentrations decreased with severity (testosterone 1.2 [2.2] vs. 6.9 [1.9] nmol/L in fatal vs. least severe, p < .001). In the follow-up cohort (n = 198, 62.1% male, 68.9% ongoing symptoms, 165 [121-192] days postdischarge), plasma cortisol concentrations (275.6 [1.5] nmol/L) did not differ with in-hospital severity, perception of recovery, or patient-reported symptoms. Male testosterone concentrations (12.6 [1.5] nmol/L) were not related to in-hospital severity, perception of recovery or symptom scores. CONCLUSIONS: Circulating glucocorticoids in patients hospitalised with COVID-19 reflect acute illness, with a marked rise in cortisol and fall in male testosterone. These findings are not observed 5 months from discharge. The lack of association between hormone concentrations and common post-COVID symptoms suggests steroid insufficiency does not play a causal role in this condition.
Source: Clinical Endocrinology
DOI: 10.1111/cen.15012
Authors: Kerri Devine, Clark D. Russell, Giovanny R. Blanco, Brian R. Walker, Natalie Z. M. Homer, Scott G. Denham, Joanna P. Simpson, Olivia C. Leavy, Omer Elneima, Hamish J. C. McAuley, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Ruth M. Saunders, Victoria C. Harris, Linzy Houchen‐Wolloff, Neil J. Greening, Nazir I. Lone, Mathew Thorpe, William Greenhalf, James D. Chalmers, Ling‐Pei Ho, Alex Horsley, Michael Marks, Betty Raman, Shona C. Moore, Jake Dunning, Malcolm G. Semple, Ruth Andrew, Louise V. Wain, Rachael A. Evans, Christopher E. Brightling, John Kenneth Baillie, Rebecca M. Reynolds, The ISARIC4C Investigators and PHOSP‐COVID Study Collaborative Group
Institutions: The Queen's Medical Research Institute, Newcastle University, University of Edinburgh, Centre for Inflammation Research, Edinburgh Cancer Research, Institute of Genetics and Cancer, University of Leicester, NIHR Leicester Biomedical Research Centre, University of Liverpool, University of Dundee, Ninewells Hospital, University of Oxford, MRC Human Immunology Unit, University of Manchester, University College Hospital, London School of Hygiene & Tropical Medicine, Hospital for Tropical Diseases, University College London, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Roslin Institute
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,050
OpenAlex ID: W4390950397