Single Serum Cortisol Value as a Prognostic Marker in Acute Ischemic Stroke

Stroke is a major global burden with significant morbidity, mortality, and long-term disability. Acute ischemic stroke (AIS) is a stressful condition causing stimulation of the hypothalamic-pituitary-adrenal (HPA) axis resulting in numerous endocrinal alterations in the body. We evaluated the serum cortisol as a prognostic marker in AIS.

This was a prospective observational study comprising 100 cases suffering from AIS, and serum cortisol at the baseline was measured. Severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) during admission, and functional outcome was assessed at 1, 4, and 24 weeks using a modified Rankins score (mRS). Statistical analysis was performed to find the relationship between serum cortisol and the severity of stroke, outcome, and mortality at 1, 4, and 24 weeks of stroke.

In our study, we found positive correlations between random blood sugar and serum cortisol (r = 0.273, p = 0.006); stroke severity (NIHSS) and serum cortisol (r = 0.785, p < 0.001); stroke outcome (mRS) at 1, 4, and 24 weeks; and serum cortisol (p < 0.001 and r = 0.676, 0.654, 0.650 for all three intervals, respectively). We also found higher serum cortisol among patients who died at 1, 4, and 24 weeks compared to those who survived with a p-value being <0.001 for all three intervals.

A stress response causing an increase in serum cortisol occurs in AIS. This response is detrimental to the patient. The serum cortisol at baseline can be considered a marker of severity, short- and long-term prognosis, and mortality after AIS.