Evaluate the serum cortisol in patients with intracerebral hemorrhage

The level of stress hormones, especially cortisol reflects stroke severity and acts as an early risk assessment of the severity of disease and prognosis. There are few neuroendocrine change and prognostic value data in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). The present study aimed to evaluate the prognostic value of cortisol in patients with acute ICH.

In a prospective observational study including 61 consecutive patients with supratentorial ICH, the morning (8 a.m.) serum cortisol level and afternoon (4 p.m.) serum cortisol level were measured to determine their value to predict functional outcome and mortality within 90 days.

Cortisol levels were increased in patients with an unfavorable functional outcome as compared to patients with a favorable functional outcome within 90 days (8 a.m. p<0.001; 4 p.m. p<0.001), and in patients who died within 90 days as compared to survivors (8 a.m. p<0.001; 4 p.m. p=0.003). For functional outcome prediction, receiver-operating-characteristics revealed an area under the curve (AUC) on admission for cortisol (8 a.m.: AUC 0.86 (95% CI 0.77-1.00)), which was statistically not different from the National Institutes of Health Stroke Scale (NIHSS) (p=0.20) or ICH score (p=0.84). For mortality prediction, cortisol had an AUC of 0.87 (95% CI 0.67-1.00), which was statistically not different from the NIHSS (p=0.58) or ICH score (p=0.68).

In our small cohort of patients with acute ICH, elevated cortisol was associated with increased mortality and worse outcome. If confirmed in a larger study, the morning serum cortisol may be used as an additional prognostic factor in ICH patients.