Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

Iranmanesh, Farhad; Sedighi, Behnaz; Ziaadini, Bentolhoda

doi:10.5812/zjrms.6187

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…Several studies (Christensen et al., 2003; Iranmanesh et al., 2017; Kwon et al., 2015; Olsson et al., 1992; Zi & Shau, 2013) have focused on the negative impact of hypercortisolemia in poststroke recovery. A Chinese study (Zi & Shau, 2013) identifies cortisol as a significant prognostic marker of functional outcome and death poststroke.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Cortisol level dysregulation and its prevalence—Is it nature's alarm clock?

Jones

Gwenin

2020

Physiol Rep

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This review examines the stress hormone cortisol which plays an important role in regulating and supporting different bodily functions. Disruption in cortisol production has an impact on health and this review looks at a wide range of papers where cortisol has been indicated as a factor in numerous chronic conditions—especially those which are classed as “noncommunicable diseases” (NCDs). Timely detection, screening, and treatment for NCDs are vital to address the growing problem of NCDs worldwide—this would have health and socioeconomic benefits. Interestingly, many of the papers highlight the pro‐inflammatory consequences of cortisol dysregulation and its deleterious effects on the body. This is particularly relevant given the recent findings concerning COVID‐19 where pro‐inflammatory cytokines have been implicated in severe inflammation.

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Section: Cardiovascular Diseasementioning

confidence: 99%

Cortisol level dysregulation and its prevalence—Is it nature's alarm clock?

Jones

Gwenin

2020

Physiol Rep

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“…The adverse cardiac effects also result from simultaneous sympathetic activation due to stress response. Some studies have shown no significant correlation between cortisol and ischemic stroke [ 5 , 13 , 14 , 15 ]. However, all of these studies involved a small number of patients, included patients with mild stroke severity only [ 15 ], or used sedatives concomitantly (midazolam or fentanyl), which may have caused variation in the results.…”

Section: Discussionmentioning

confidence: 99%

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

Saini¹,

Kaur²,

Bhatia³

et al. 2023

Cureus

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Background: 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-pituitaryadrenal (HPA) axis resulting in numerous endocrinal alterations in the body. We evaluated the serum cortisol as a prognostic marker in AIS.Methods: 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.Results: 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. Conclusions: 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.

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“…In patients with acute IS, high serum cortisol at admission correlated with clinical severity according to NIHSS, as well as poor prognosis and functional outcome evaluated by the modified Rankin Scale [ 36 ]. In the majority of studies, cortisol levels were high in the first week after IS, and higher cortisol was associated with dependency, morbidity, depression, and mortality [ 37 ], though single studies demonstrated that, although IS was associated with a change in serum cortisol level, this change had no prognostic value [ 38 ]. In our study, comparative analysis of patients after IS and HC group revealed significantly elevated cortisol levels during the year after IS, starting from day 30 ( Figure 1 a), and persisting during the follow-up period ( Figure 3 a), though no significant changes in ACTH levels could be detected ( Figure 3 b).…”

Section: Discussionmentioning

confidence: 99%

Development of Post-Stroke Cognitive and Depressive Disturbances: Associations with Neurohumoral Indices

Zhanina

Дружкова

Yakovlev

et al. 2022

CIMB

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Neuropsychiatric complications, in particular cognitive and depressive disorders, are common consequences of ischemic stroke (IS) and complicate the rehabilitation, quality of life, and social adaptation of patients. The hypothalamic–pituitary–adrenal (HPA) system, sympathoadrenal medullary system (SAMS), and inflammatory processes are believed to be involved in the pathogenesis of these disorders. This study aimed to explore these systems in IS patients, including those with post-stroke cognitive and depressive disorders, within a year after IS. Indices of the HPA axis, inflammatory system, and SAMS were measured in blood serum (cortisol, interleukin-6 (IL-6)), plasma (adrenocorticotropic hormone), and saliva (cortisol, α-amylase). During one year after mild/moderate IS (NIHSS score 5.9 ± 4.3), serum cortisol and salivary α-amylase levels remained elevated in the total cohort. In the group with further cognitive decline, serum and salivary cortisol levels were elevated during the acute period of IS. In the group with poststroke depressive disorder, salivary α-amylase was constantly elevated, while serum IL-6 was minimal during the acute period. The results suggest prolonged hyperactivation of the HPA axis and SAMS after IS. Specifically, post-stroke cognitive impairment was associated with hyperactivation of the HPA axis during the acute IS period, while post-stroke depressive disorder was associated with the chronic inflammatory process and hyperactivation of SAMS during the follow-up period.

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Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

Cited by 6 publications

References 26 publications

Cortisol level dysregulation and its prevalence—Is it nature's alarm clock?

Cortisol level dysregulation and its prevalence—Is it nature's alarm clock?

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

Development of Post-Stroke Cognitive and Depressive Disturbances: Associations with Neurohumoral Indices

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