A study on correlation between serum cortisol and severity of acute ischemic stroke in patients admitted in Govt Kilpauk Medical College Hospital, Chennai

INTRODUCTION: 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 a 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 hypothalamo–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 in the Kilpauk Medical College Hospital were included in the study.The study was conducted for a period of 6 months. CT Brain was taken during admission to confirm acute ischemic stroke. NIHSS (National Institute of Health Stroke Scale) score for all the patients were assessed for severity at the time of admission.Serum cortisol levels were measured on the next day early morning. After 15 days, the functional outcome of the patients were assessed using Modified Rankin Scale. Correlation between serum cortisol levels and stroke scales are assessed by Chi – Square Test.All statistical analysis are performed using SPSS (software package used for statistical analysis) package. RESULTS: Of the 50 cases, serum cortisol level of 23 cases were within normal limits(</=690nmol/L) of which 65.2% had NIHSS score of less than or equal to 6 and 34.8% of the cases had NIHSS score 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 findings that most of the cases with normal cortisol level had no major stroke. Remaining 27 cases had elevated serum cortisol levels.100% of the cases with serum cortisol level of more than 690nmol/L had NIHSS score above 6.With the p value of <0.001 this is found to be statistically significant. 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 level 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 score less than or equal to 3 and 21.7% had MRS score more than 3.Since 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 findings 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 level more than 690 nmol/L, 3.7% had MRS score of less than or equal to 3 and 96.3% had MRS score of more than 3.With the p value of