Could serum total cortisol level at admission predict mortality due to coronavirus disease 2019 in the intensive care unit? A prospective study
São Paulo med. j
;
139(4): 398-404, Jul.-Aug. 2021. tab, graf
Article
in English
| LILACS
| ID: biblio-1290241
ABSTRACT
ABSTRACT BACKGROUND:
Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis.OBJECTIVES:
To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. DESIGN ANDSETTING:
Prospective study developed in a pandemic hospital in the city of Şırnak, Turkey.METHODS:
We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU.RESULTS:
The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 μg/dl versus 16.47 μg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio 1.20; 95% confidence interval 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 μg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 μg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 μg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001).CONCLUSION:
Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Hydrocortisone
/
COVID-19
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
Language:
English
Journal:
São Paulo med. j
Journal subject:
Cirurgia Geral
/
Cincia
/
Ginecologia
/
Medicine
/
Medicina Interna
/
Obstetr¡cia
/
Pediatria
/
Sa£de Mental
/
Sa£de P£blica
Year:
2021
Type:
Article
Affiliation country:
Turkey
Institution/Affiliation country:
Department of Endocrinology and Metabolism/TR
/
Department of Intensive Care/TR
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