• Critical care medicine · Dec 2021

    Observational Study

    Increased Glucocorticoid Receptor Alpha Expression and Signaling in Critically Ill Coronavirus Disease 2019 Patients.

    • Alice G Vassiliou, Nikolaos Athanasiou, Chrysi Keskinidou, Edison Jahaj, Stamatios Tsipilis, Alexandros Zacharis, Efthimia Botoula, Aristidis Diamantopoulos, Ioannis Ilias, Dimitra A Vassiliadi, Stylianos Tsagarakis, Anastasia Kotanidou, and Ioanna Dimopoulou.
    • 1st Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
    • Crit. Care Med. 2021 Dec 1; 49 (12): 213121362131-2136.

    ObjectivesCritical illness is characterized by increased serum cortisol concentrations and bioavailability resulting from the activation of the hypothalamic-pituitary-adrenal axis, which constitutes an essential part of the stress response. The actions of glucocorticoids are mediated by a ubiquitous intracellular receptor protein, the glucocorticoid receptor. So far, data on coronavirus disease 2019 and glucocorticoid receptor alpha expression are lacking.DesignProspective observational study.SettingOne academic multidisciplinary ICU.SubjectsTwenty-six adult coronavirus disease 2019 patients; 33 adult noncoronavirus disease 2019 patients, matched for age, sex, and disease severity, constituted the control group. All patients were steroid-free.InterventionsNone.Measurements And Main ResultsGlucocorticoid receptor alpha, glucocorticoid-inducible leucine zipper expression, and serum cortisol were measured on ICU admission. In coronavirus disease 2019 patients, glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper messenger RNA expression were upregulated (4.7-fold, p < 0.01 and 14-fold, p < 0.0001, respectively), and cortisol was higher (20.3 vs 14.3 μg/dL, p < 0.01) compared with the control group.ConclusionsICU coronavirus disease 2019 patients showed upregulated glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper expression, along with cortisol levels, compared with ICU noncoronavirus disease 2019 patients. Thus, on ICU admission, critical coronavirus disease 2019 appears to be associated with hypercortisolemia, and increased synthesis of glucocorticoid receptor alpha and induced proteins.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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