A STUDY ON THE CORRELATION BETWEEN SERUM CORTISOL LEVELS AND SEVERITY OF ACUTE ISCHEMIC STROKE.

Abstract

INTRODUCTION: There are many clinical variables like symptom severity and advanced age which are identied 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 AIM AND OBJECTIVE: To assess the relationship of single serum cortisol levels to the severity of acute ischemic stroke. MATERIALS AND METHODS: About 50 new cases of acute ischemic stroke patients, within 72 hours of the acute neurological event, who were admitted to the Chalmeda Anand Rao institute of medical sciences, Karimnagar, Telangana were included in the study. The study was conducted for 6 months.CT Brain was taken during admission to conrm acute ischemic stroke. NIHSS (National Institute of Health Stroke Scale) scores for all the patients were assessed for severity at the time of admission. Serum cortisol levels were measured the next day early morning. After 15 days, the functional outcome of the patients was assessed using the Modied Rankin Scale. The correlation between serum cortisol levels and stroke scales is assessed byChi–Square Test. All statistical analyses are performed using SPSS (software package used for statistical analysis) package. RESULTS: Of the 50 cases, the serum cortisol level of 23 cases was within normal limits(</=690nmol/L) of which 65.2% had NIHSS scores of less than or equal to 6 and 34.8% of the cases had NIHSS scores more than 6. As the NIHSS score of less than or equal to 6 is considered to be a minor stroke, it is obvious from the above ndings that most of the cases with normal cortisol levels had no major stroke. The remaining 27 cases had elevated serum cortisol levels.100% of the cases with serum cortisol levels of more than 690nmol/L had NIHSS scores above 6. With a p-value of <0.001, this is found to be statistically signicant. As the NIHSS score above 6 is considered to be moderate to severe stroke, it is obvious from the above observation that nearly all cases with elevated cortisol levels had moderate to severe stroke. Of the 50 cases, serum cortisol levels of 23 cases were within normal limits(,/=690nmol/L)of which 78.3% had MRS scores less than or equal to 3 and 21.7% had MRS scores more than 3. Since the MRS score is a measure of functional outcome and any score less than or equal to 3 is considered to have a favourable outcome, it is clear from the above ndings that most of the cases with normal serum cortisol had a favourable outcome with minimal neurological impairment. And in the remaining 27 cases which had serum cortisol levels of more than 690 nmol/L, 3.7% had an MRS score of less than or equal to 3 and 96.3% had an MRS score of more than 3. With a p-value of <0.001, this is statistically signicant. Since an MRS score of more than 3 is associated with a bad outcome, most of the cases with elevated serum cortisol had a poor outcome with severe neurological impairment. CONCLUSION: Among the patients with acute ischemic stroke, high serum cortisol levels at the time of admission correlate with, Clinical severity which is assessed by the National Institute of Health Stroke Scale and Poor prognosis and functional outcome after 15 days which is assessed by the Modied Rankin Scale