Plasma steroid concentrations reflect acute disease severity and normalise during recovery in people hospitalised with COVID-19.
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Devine Kerri, Russell Clark D, Blanco Giovanny R, Walker Brian R, Homer Natalie Z M, Denham Scott G, Simpson Joanna P, Leavy Olivia C, Elneima Omer, McAuley Hamish J C, Shikotra Aarti, Singapuri Amisha, Sereno Marco, Saunders Ruth M, Harris Victoria C, Houchen-Wolloff Linzy, Greening Neil J, Lone Nazir I, Thorpe Mathew, Greenhalf William, Chalmers James D, Ho Ling-Pei, Horsley Alex, Marks Michael, Raman Betty, Moore Shona C, Dunning Jake, Semple Malcolm G, Andrew Ruth, Wain Louise V, Evans Rachael A, Brightling Christopher E, Kenneth Baillie John, Reynolds Rebecca M, ISARIC4C Investigators and PHOSP-COVID Study Collaborative Group
Аннотация
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.