STRESS LEVEL IN SCHOOL-AGE CHILDREN WITH COVID-19
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i4.14306Keywords:
children, COVID-19, stress, cortisolAbstract
SUMMARY. The aim – to find out the level of stress in school-aged children with different courses of COVID-19 by determining their level of free salivary cortisol.
Material and Methods. Totally 90 children aged 6 to 18 years were examined: 60 patients with manifestations of laboratory-confirmed SARS-CoV-2 infection and 30 children without signs of the disease (control group). The level of free salivary cortisol was assessed in all children of this study. According to the severity of the disease, 3 groups were formed: the first – 20 children with a mild course of COVID-19, the second group – 31 patients with a moderate to severe course of the disease, the third – 9 children with severe COVID-19. Quantitative determination of the level of free cortisol in saliva was carried out by enzyme-linked immunosorbent assay (Cortisol Saliva Elisa, TECAN, Hamburg, Germany). The result was evaluated in micrograms/deciliter (μg/dL). Statistical analysis was carried out using the "Stat Plus" program. The result was considered statistically significant at p<0.05.
Results. The mean age of all children was (11.47±to 3.80) years. There was no significant difference between sex (c2=4.97; p=0.174) and age (p=0.490) in the study groups. The mean level of free salivary cortisol in children of the control group was 0.158 [0.088; 0.365] μg/dL, in children with manifestations of SARS-CoV-2 infection – 0.740 [0.313; 1.024] μg/dL (p<0.001). There was no significant difference in cortisol values between male and female patients (p=0.355). A significant increase in the level of this indicator was associated with the severity of the disease (H=27.30, P<0.001). There is a positive medium-strength correlation between the level of free cortisol and ESR (r=0.47, p<0.001), CRP (r=0.42, p<0.001), glycemic level (r=0.47, p=0.004), procalcitonin (r=0.31, p=0.044) duration of hyperthermia (r=0.39, p=0.006), duration of treatment (r=0.42, p=0.002).
Conclusions. Pediatric patients with COVID-19 have a higher level of stress, which reliably depends on the course of this disease. In children with manifestations of COVID-19, significantly higher levels of free salivary cortisol were observed compared to the control group, which indicates a higher level of stress in this group of patients. A significant increase in free cortisol levels is associated with an increase in pro-inflammatory markers (ESR, CRP, procalcitonin), as well as the duration of treatment and the duration of hyperthermia, indicating an increase in the severity of the disease. Cortisol in combination with other markers may be useful as a prognostic marker of disease outcome. Determination of cortisol levels in patients with COVID-19 may lead to new directions in the treatment of this disease.
References
Levenson, R.W. (2020). Stress and illness: A role for specific emotions. Psychosomatic Medicine, 81(8), 720-730. DOI: 10.1097/PSY.0000000000000736.
Nicolaides, N.C., Charmandari, E., Kino, T., & Chrousos, G.P. (2017). Stress-related and circadian secretion and target tissue actions of glucocorticoids: impact on health. Front. Endocrinol., 8(70). DOI: 10.3389/fendo.2017.00070.
Regitz-Zagrosek, V., Mauvais-jarvis, F., Hofmann, S., Holly, J. M. P., Kautzky-Willer, A., & Bao, W., (2022). Endocrinology and COVID-19: A Cross-Disciplinary Topic. Lausanne: Frontiers Media SA, 91-94. DOI: 10.3389/978-2-88976-977-3.
Gallagher, M.W., Zvolensky, M.J., Long, L.J., Rogers, A.H., & Garey, L. (2020). The Impact of Covid-19 Experiences and Associated Stress on Anxiety, Depression, and Functional Impairment in American Adults. Cognitive therapy and research, 44(6), 1043-1051. DOI: 10.1007/s10608-020-10143-y.
Tan, T., Khoo, B., Mills, E.G., Phylactou, M., Patel, B., Eng, P., & Dhillo, W.S. (2020). Association between high serum total cortisol concentrations and mortality from COVID-19. The Lancet. Diabetes & endocrinology, 8(8), 659-660. DOI: 10.1016/S2213-8587(20)30216-3.
El-Farhan, N., Rees, D.A., & Evans, C. (2017). Measuring cortisol in serum, urine and saliva – are our assays good enough? Annals of clinical biochemistry, 54(3), 308-322. DOI: 10.1177/0004563216687335.
Nicolaides, N.C., Charmandari, E., Kino, T., & Chrousos, G.P. (2017). Stress-Related and Circadian Secretion and Target Tissue Actions of Glucocorticoids: Impact on Health. Frontiers in endocrinology, 8(70). DOI: 10.3389/fendo.2017. 00070.
Ahmadi, I., Babaki E.H., Maleki, M., Jarineshin, H., Kaffashian, M.R., Hassaniazad, M., Kenarkoohi, A., & Sohrabipour, S. (2022). Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study. International journal of endocrinology. DOI: 10.1155/2022/ 4280691.
Güven, M., & Gültekin, H. (2021). Could serum total cortisol level at admission predict mortality due to coronavirus disease 2019 in the intensive care unit? A prospective study. Sao Paulo medical journal, 139(4), 398-404. DOI: 10.1590/1516-3180.2020.0722.R1.2302021.
Pal, R. (2020). COVID-19, hypothalamo-pituitary-adrenal axis and clinical implications. Endocrine, 68(2), 251-252. DOI: 10.1007/s12020-020-02325-1.
World Health Organization (2021). COVID-19 clinical management: living guidance, 25 January 2021. World Health Organization. Retrivered from: https://iris.who.int/handle/10665/338882.
(2020). Nakaz MOZ Ukrayiny № 2583 vid 11.11.2020 roku pro zatverdzhennya Protokolu «Nadannya medychnoyi dopomohy dlya likuvannya koronavirusnoyi khvoroby (COVID-19)» [Order of the MOH of Ukraine No. 2583 dated 11.11.2020 on approval of the Protocol “Provision of medical care for the treatment of coronavirus disease (COVID-19)”]. Retrivered from: http:// moz.gov.ua/uploads/ 5/27190-dn_2583_11_11_2020_dod.pdf [in Ukrainian].
Semiz, S. (2022). COVID19 biomarkers: What did we learn from systematic reviews? Frontiers in cellular and infection microbiology, 12. DOI: 10.3389/fcimb.2022. 1038908.
Kim, Y.J., Kim, J.H., Hong, A.R., Park, K.S., Kim, S.W., Shin, C.S., & Kim, S.Y. (2020). Stimulated Salivary Cortisol as a Noninvasive Diagnostic Tool for Adrenal Insufficiency. Endocrinology and metabolism (Seoul, Korea), 35(3), 628-635. DOI: 10.3803/EnM.2020.707.
Choi, M.H. (2022). Clinical and Technical Aspects in Free Cortisol Measurement. Endocrinology and metabolism (Seoul, Korea), 37(4), 599-607. DOI: 10.3803/EnM.2022.1549.
Perry, N.B., Donzella, B., Troy, M.F., & Barnes, A.J. (2022). Mother and child hair cortisol during the COVID-19 pandemic: Associations among physiological stress, pandemic-related behaviors, and child emotional-behavioral health. Psychoneuroendocrinology, 137. DOI: 10.1016/j.psyneuen.2021.105656.
Yavropoulou, M.P., Filippa, M.G., Mantzou, A., Ntziora, F., Mylona, M., Tektonidou, M.G., & Sfikakis, P.P. (2022). Alterations in cortisol and interleukin-6 secretion in patients with COVID-19 suggestive of neuroendocrine-immune adaptations. Endocrine, 75(2), 317-327. DOI: 10.1007/s12020-021-02968-8.
Mao, Y., Xu, B., Guan, W., Xu, D., Li, F., Ren, R., Zhu, X., Gao, Y., & Jiang, L. (2021). The Adrenal Cortex, an Underestimated Site of SARS-CoV-2 Infection. Frontiers in endocrinology, 11. DOI: 10.3389/fendo.2020.593179.
Miller, G.E., Cohen, S., & Ritchey, A.K. (2002). Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychol., 21(6), 531-541. DOI: 10.1037//0278-6133.21.6.531.
Munnink, O., Koopmans, B.B., & Tracking, M. (2023). SARS-CoV-2 variants and resources. Nat. Methods, 20, 489-490. DOI: 10.1038/s41592-023-01833-y.
Choy, K.W. (2020). Cortisol concentrations and mortality from COVID-19. The Lancet. Diabetes & endocrinology, 8(10), 808. DOI: 10.1016/S2213-8587(20)30305-3.
