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Adrenal function in relation to cytokines and outcome in non-critically ill patients with COVID-19

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Abstract

Purpose

We aimed to identify whether hypothalamic–pituitary–adrenal (HPA) axis dysfunction is related to deterioration in a percentage of patients who progress to severe COVID-19.

Methods

In this cohort observational study, we evaluated HPA axis activation by measuring cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone sulfate (DHEA-S) levels, whole blood expression levels of the key glucocorticoid receptor, GCR-α, and the glucocorticoid-induced leucine zipper (GILZ), and cytokines, as markers of the inflammatory phase, in 149 patients with respiratory infection admitted in the ward, without known adrenal disease and/or confounding medications (glucocorticoids). One hundred and four (104) patients were SARS-CoV-2 positive (C +) and controls consisted of 45 SARS-CoV-2-negative patients (NC).

Results

No differences in cortisol levels were observed between the C + and the NC patients. Cortisol levels correlated with ACTH (r = 0.284, p = 0.001) and IL-6 (r = 0.289, p = 0.04). In C + patients, cortisol levels mainly correlated with IL-6 levels (r = 0.28; p = 0.017). GCR-α expression was significantly higher in C + patients compared to NC. Patients with higher cortisol levels were more likely to progress to respiratory function deterioration or die. Both GCR-α and GILZ expression were significantly higher in C + non-survivors.

Conclusion

Our findings indicate that cortisol serves as an indicator of disease severity. GILZ expression appears to be a more effective marker of mortality prediction in moderate COVID-19 cases. However, routine measurement of GILZ levels is currently unavailable. Elevated levels of cortisol may be indicative of patients with moderate COVID-19 who are at a higher risk of deterioration. This information can aid in identifying individuals who require early medical attention.

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Data availability

Data are available upon reasonable request.

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Funding

No funding was received for conducting this study.

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Author notes

  1. N. Athanasiou and A. Diamantopoulos have contributed equally to this work.

Authors and Affiliations

  1. First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece

    N. Athanasiou, C. Keskinidou, P. Katsaounou, E. Jahaj, C. S. Vrettou, A. G. Vassiliou, A. Kotanidou & I. Dimopoulou

  2. Department of Endocrinology Diabetes and Metabolism, National and European Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece

    A. Diamantopoulos, P. Mourelatos, E. Botoula, S. Tsagarakis & D. A. Vassiliadi

  3. First Department of Internal Medicine, Unit of Endocrinology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    A. Angelousi

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  1. N. Athanasiou
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  2. A. Diamantopoulos
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  3. C. Keskinidou
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  4. P. Katsaounou
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  5. A. Angelousi
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  6. E. Jahaj
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  7. P. Mourelatos
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  8. C. S. Vrettou
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  9. E. Botoula
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  10. A. G. Vassiliou
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  11. A. Kotanidou
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  12. S. Tsagarakis
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  13. I. Dimopoulou
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  14. D. A. Vassiliadi
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Corresponding author

Correspondence to D. A. Vassiliadi.

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Athanasiou, N., Diamantopoulos, A., Keskinidou, C. et al. Adrenal function in relation to cytokines and outcome in non-critically ill patients with COVID-19. J Endocrinol Invest 47, 721–728 (2024). https://doi.org/10.1007/s40618-023-02189-y

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  • DOI: https://doi.org/10.1007/s40618-023-02189-y

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