Endocrine Abstracts

Background: Stroke is the second commonest reason of mortality worldwide and a major cause of long term disability. Early prediction of outcome is important for allocation of therapeutic strategies. Endocrine alterations of the hypothalamus–pituitary–axis (HPA) are one of the first stress-induced alterations after cerebral ischemia. We evaluated the prognostic value of cortisol for outcome in acute ischemic cerebrovascular events.

Method: In an observational study including 362 patients with an ischemic stroke cortisol was measured on admission. We compared its prognostic accuracy to the National Institute of Health Stroke Scale Score (NIHSS) and to other known predictors with respect to functional outcome (as assessed by the modified Ranking scale) and mortality.

Results: Patients with an unfavorable outcome and non-survivors had higher cortisol levels on admission compared to patients with a good outcome and survivors, respectively (582 nmol/l (439–727) vs 444 nmol/l (318.5–585.5) and 681 nmol/l (573–1082) vs 466 nmol/l (337–598); P<0.0001 and P<0.0001). The area under the receiver operating characteristics (ROC) curve to predict mortality for cortisol with an AUC of 0.81 (0.76–0.86) was in the range of the NIHSS with an AUC of 0.85 (0.8–0.89). Cortisol had a higher prognostic accuracy as compared to glucose (AUC 0.59 (0.53–0.66), P=0.002), white blood count (WBC) (AUC 0.66 (0.53–0.67), P=0.004) and Charlson co-morbidity index (CCI) AUC 0.59 (0.53–0.65), P=0.007). In univariate logistic regression analysis, cortisol was a significant predictor of death and functional outcome with unadjusted ORs of 1.004 (95% CI 1.003–1.006) and 1.003 (95% CI 1.001–1.004). After adjusting for age, blood pressure, CRP, glucose, temperature and gender, cortisol remained an independent outcome predictor with adjusted ORs of 1.005 (95% CI 1.002–1.008) and 1.002 (95% CI 1.001–1.004).

Conclusion: Cortisol is a prognostic marker to predict functional outcome and death in patients with an ischemic stroke, comparable to the NIHSS.