A STUDY ON THE CORRELATION BETWEEN SERUM CORTISONE LEVELS AND STROKE SEVERITY

Abstract

BACKGROUND:

There are many clinical variables like symptom severity and advanced age which are identified as potential predictors of outcome in patients with acute stroke. But there is an immense need to detect a biomarker for predicting the outcome of acute stroke. The stress response that occurs after the event of acute stroke causes the activation of the hypothalamic–pituitary–adrenal (HPA) axis. Certain studies have found that increased serum cortisol level in patients with acute stroke is related to larger infarct volume, greater stroke severity, and poor outcome, including death. The primary objective of this study dissertation is to test the hypothesis that an increased single serum cortisol level is associated with increased severity of acute ischemic stroke. Though cortisol level has diurnal variations it has been shown that the normal circadian rhythm of cortisol is suspended during the acute stroke and there is no variation of cortisol level in serum throughout the day due to perturbations in the HPA axis.

AIM: The aim of the study was to investigate if a single Serum cortisol level determination could predict the outcome of stroke. Whether Serum cortisol as well as stroke severity is related to any clinical or paraclinical parameters of known relevance in acute stroke.

 MATERIAL AND METHOD:

The study was a Cross-sectional descriptive study has been conducted in the Department of General Medicine. A total of 50 patients were included in the study. The patients were recruited from the department of General Medicine Hospital. Written informed consent was taken from all the patients. All patients included in the study who was admitted within 6 hours in the hospital after the episode of stroke. Vital signs such as blood pressure, pulse rate, and body temperature were continuously monitored. The Scandinavian Stroke Scale (SSS)xx was monitored in all patients from admission. SSS was performed every 2 hours in the first 24 hours, every 4 hours in the next 48 hours, and then daily up to day 7.

RESULTS:

the mean age observed in the current series was 62.8 ± 10.48 years. There were 38 (73.1%) males and 12(27.9%) females. SSS was observed to be 35 (21-47) on admission. History of hypertension, History of stroke, Diabetes mellitus, and Atrial fibrillation was observed in 34(59.4%), 10(18.8%), 24(37.5%), and 9(17.2%) respectively. 44% with stroke were smokers (20 patients), 32% were alcoholics (14 patients)10 patients were both alcoholics and smokers (22%) Out of 50 patients, 16 patients had Hemorrhagic stroke& 34 patients had an ischemic stroke. The mean cortisol level was about 16.40 mg/dl with an SD of 8.87mg/dl Mean cortisol value was significantly higher in patients with hemorrhagic stroke than in patients with ischemic stroke.

CONCLUSION:

High serum cortisol correlated with the severity of stroke as evidenced by an inverse relation with SSS. As serum cortisol level increases SSS score decreases. High serum cortisol is also correlated with systolic blood pressure, diastolic blood pressure, total count, and admission blood sugar level. The highest correlation coefficient was observed with random blood sugar level at admission and the lowest was for diastolic blood pressure. This shows that admission blood sugar level correlates well with serum cortisol and hence with stroke severity.

KEYWORDS: Acute ischemic stroke, HPA axis, serum cortisol, clinical severity, Functional outcome and stroke scales