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Clinical Endocrinology - 2024 - Devine - Plasma steroid concentrations reflect acute disease severity and normalise during.pdf (993.14 kB)

Plasma steroid concentrations reflect acute disease severity and normalise during recovery in people hospitalised with COVID-19

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posted on 2024-02-20, 14:46 authored by K Devine, CD Russell, GR Blanco, BR Walker, NZM Homer, SG Denham, JP Simpson, OC Leavy, O Elneima, HJC McAuley, A Shikotra, A Singapuri, M Sereno, RM Saunders, VC Harris, L Houchen-Wolloff, NJ Greening, NI Lone, M Thorpe, W Greenhalf, JD Chalmers, LP Ho, A Horsley, M Marks, B Raman, SC Moore, J Dunning, MG Semple, R Andrew, LV Wain, RA Evans, Christopher BrightlingChristopher Brightling, J Kenneth Baillie, RM Reynolds
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.

Funding

National Institute for Health and Care Research

National Institute for Health Research Health Protection Research Unit

Medical Research Council

Medical Research Scotland

Bill and Melinda Gates Foundation

Liverpool Experimental Cancer Medicine Centre

Wellcome Trust

NIHR Biomedical Research Centre at Imperial College

EU Platform foR European Preparedness Against (Re-) emerging Epidemics

NHS Research Scotland

History

Author affiliation

College of Life Sciences/Population Health SciencesCollege of Life Sciences/Respiratory Sciences

Version

  • VoR (Version of Record)

Published in

Clinical Endocrinology

Publisher

Wiley

issn

0300-0664

eissn

1365-2265

Copyright date

2024

Available date

2024-02-20

Spatial coverage

England

Language

eng

Deposited by

Dr Rachael Evans

Deposit date

2024-02-17

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