Serum Cortisol Concentration and COVID-19 Severity: A Systematic Review and Meta-Analysis

Abstract

The novel COVID-19 outbreak is a major health threat to human beings with multiorgan injuries. However, its endocrine system manifestations are much less studied. In this study, we aimed to reassess the available findings on the association between cortisol level and severity of COVID-19 infection. We conducted a systematic search on Medline/PubMed, Scopus, Web of Science, and Cochrane Library databases. To pool data, a random-effects model was performed depending on the heterogeneity among studies. Sensitivity analysis was also carried out by removing each study systematically. In addition, subgroup and meta-regression analyses were performed depending on the presence of the variables of sex and age. Subsequently, 11 studies (5 observational studies and 6 case reports) were included in the meta-analysis. Pooled analysis on the observational studies showed significantly higher levels of cortisol in patients with severe COVID-19 in comparison with those with mild-to-moderate COVID-19 (standardized mean difference: 1.48 µg/dL; 95% CI (0.51 to 2.46); p=0.003). Assessment of the results of case reports revealed that the patients with severe COVID-19 demonstrated higher cortisol levels than the patients with mild-to-moderate COVID-19. No publication bias was observed using the Begg’s (p=0.08) and Egger’s tests (p=0.09). Meta-regression illustrated a significant correlation between cortisol levels with sex. The serum cortisol level seems to be higher in patients with severe COVID-19 infection. This finding could be helpful to detect patients with poor prognosis at early stages of the disease, although age and sex may modify this level.

COVID-19 Pneumonia in Patients with Impaired Fasting Glucose, Newly Diagnosed Diabetes and Pre-Existing Diabetes: A Tertiary Center Experience

“…Limited data suggested a link between COVID-19 and endocrine status. It was hypothesized that stress during severe COVID-19 leads to hypothalamic–pituitary axis activation and as a result elevates serum cortisol secretion 27. On the other hand, comorbidities such as hypertension, obesity, cardiovascular causes, and kidney damage accompanying diabetes may be associated with the composite endpoints and mortality in COVID-19.…”

Covid-19 and Parkinson's disease: Acute clinical implications, long-COVID and post-COVID-19 parkinsonism

“…While motor performance often seems to improve under conditions of acute stress, chronic anxiety and stress on the other hand tend to characteristically aggravate motor symptoms in PwP, particularly resting tremor ( Moore, Rose, & Grace, 2001 ). It is, therefore, of interest that a SARS-CoV-2 infection, in particular more severe infections, have consistently increased serum cortisol levels, as demonstrated in a recent meta-analysis and systematic review by Amiri-Dashatan and colleagues ( Amiri-Dashatan, Koushki, Parsamanesh, & Chiti, 2022 ). Although the effects of increased cortisol levels on motor symptoms in PwP remain elusive ( van Wamelen et al, 2020 ), higher serum cortisol levels appear to be more consistently associated with anxiety levels, risk-taking, sleep problems, and depressive symptoms in PwP ( Breen et al, 2014 ; Djamshidian et al, 2011 ; Muller & Muhlack, 2007 ; Ruzicka et al, 2015 ).…”

Selective Amplification of Plasmonic Sensor Signal for Cortisol Detection Using Gold Nanoparticles

“…Excess cortisol in the body can cause obesity, fatigue, bone fragility, and Cushing’s syndrome and cortisol deficiency can cause Addison’s disease with symptoms of fatigue, excessive weight loss, and darkening of skin folds [ 2 ]. Elevations in cortisol levels can lead to brain aging, cognitive damage, sarcopenia, a decreased bone mineral density, and an impaired immune system and the disruption of cortisol levels is often accompanied by the severity of other illnesses such as COVID-19 [ 3 , 4 , 5 , 6 ]. For all of these reasons, the development of an effective, sensitive, and selective method for the detection of cortisol has great importance.…”