Since patients with COVID-19 frequently have obesity and presumably higher levels of insulin due to insulin resistance, this might be a partial explanation for lower levels of SHBG.[22] Additionally, hypoalbuminaemia due to increased vascular permeability and capillary leakage is common in critically ill patients,[23] and a similar mechanism could lead to low SHBG concentrations. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.