Published: 22 June 2020
A new NIHR funded study suggests COVID-19 patients with extremely high levels of the stress hormone cortisol in their blood are more likely to deteriorate quickly. Led by NIHR Research Professor Waljit Dhillo, this research is the first time that cortisol levels have been shown to be a marker of the severity of the illness and could be used to identify which patients are more likely to need intensive care.
In this new observational study published in The Lancet Diabetes & Endocrinology, cortisol levels in patients with COVID-19 were significantly higher than in those without. Amongst the COVID-19 patients, those with a baseline cortisol level of 744 or less survived on average for 36 days. Patients with levels over 744 had an average survival of just 15 days.
The body produces cortisol in response to stress, such as illness, which triggers changes in metabolism, heart function and the immune system to help our bodies cope.
Professor Waljit Dhillo, NIHR Research Professor and Consultant Endocrinologist at Imperial College Healthcare NHS Trust, 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 was funded by NIHR and MRC, and was supported by the NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre (BRC) at Imperial College Healthcare NHS Trust.
Professor Waljit Dhillo is funded by an NIHR Research Professorship and co-author Ali Abbara is funded by an NIHR Clinician Scientist Award. Both usually study the effects of hormones on reproductive health, however the team returned to the frontline of the NHS to provide care for COVID-19 patients during the peak of the pandemic and were able to undertake this research. Professor Dhillo and his team at Imperial College London are hoping that their findings can now be validated in a larger scale clinical study.