Corticosteroid therapy involves the activated glucocorticoid receptor α

GC-GRα

Corticosteroids

A study on patients in Wuhan, China, indicated that systemic corticosteroid treatment may have no significant effect, or potentially a negative effect, on in-hospital mortality rates for severe and critical COVID-19 cases.

Effect of Systemic Corticosteroids on Mortality in Severe and Critical COVID-19

SARS-CoV-2 negatively impacts the cortisol stress response. Corticosteroid therapy is efficient in treating severe COVID-19


Michigan State University

Cortisol is a corticosteroid hormone synthesized from cholesterol in the adrenal glands. It regulates metabolism and the immune response, and is released in response to stressors or low blood glucose levels.

Cortisol

Arabi, Y. M., Chrousos, G. P., & Meduri, G. U. (2020). The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Intensive Care Medicine. https://doi.org/10.1007/s00134-020-06223-y

The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19

- Those with COVID-19 showed a greater acute cortisol stress response compared to those who did not contract COVID-19.
- There is a positive association between cortisol levels and mortality
   - If cortisol levels increased, then the likelihood of death would increase
- Patients did not show adrenal insufficiency immediately, which is caused by low cortisol levels, but adrenal insufficiency will mostly increase a while after the onset of the virus
- In a study, it was found that when cortisol levels were greater than 744 nmol/L, there was a decrease in survival probability over a span of 42 days

Cortisol Concentrations and COVID-19 Mortality

- The HADS scale was used to determine levels of anxiety and depression
- It was found that there is a statistically significant relationship between the HADS score and cortisol levels
  - As levels of depression and anxiety increased, cortisol levels also increased
- COVID-19 Patients who had passed away had higher serum cortisol levels compared to the COVID-19 patients that survived
- Stress increases one’s susceptibility to respiratory tract infections, making patients more vulnerable to getting a cold
  - The immune cells become unable to regulate inflammation
- As tissues become less sensitive to cortisol due to high levels of stress, it becomes more difficult to regulate stress levels

Anxiety and Cortisol Levels in COVID-19 Patients

Diurnal cortisol secretions (AUCg) and the cortisol awakening response (CAR) play a role in determining how susceptible someone is to the SARS-CoV-2 virus.

Diurnal cortisol secretions (AUCg) and the cortisol awakening response (CAR)

Hydrocortisone is a synthetic version of the corticosteroid hormone cortisol, which is naturally synthesized from cholesterol within the adrenal glands. Used as a topical treatment, it suppresses localized immune activity by decreasing the secretion of histamine, thereby reducing inflammation, rashes, and itching (pruritus).

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