Increasing of Cortisol Level and Neutrophil-Lymphocyte-Ratio are Associated with Severity Level and Sleep Disturbances in Acute Ischemic Stroke

Lisda Amalia, Mitha Dewi Garyani, Nushrotul Lailiyya Department of Neurology, Medical Faculty, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Lisda Amalia, Department of Neurology, Medical Faculty, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Jl. Eykman 38, Bandung, 40161, Indonesia, Email dr.lisda@gmail.comBackground: Acute ischemic stroke can cause sleep disturbances. These complaints involve various factors, such as disturbances of the hormone cortisol and Neutrophil-Lymphocyte-Ratio (NLR) that can cause increasing severity levels in acute ischemic stroke patients. This study aimed to determine the relationship between cortisol levels and NLR with severity levels and sleep disturbances in acute ischemic stroke patients.Methods: A cross-sectional analytic observational study was conducted on acute ischemic stroke patients during Agustus – December 2022. Examine cortisol levels using the ELISA method, NLR from blood test, asses severity levels using the National Institute of Health Stroke Scale (NIHSS), and The Pittsburgh Sleep Questionnaire Index (PSQI) is used as a measure for the initial screening of sleep disturbances—statistical analysis using Spearman correlation.Results: Total study subjects were 48 patients, with the majority 62.5% women; the mean age of study subjects was above 60 years (56.3%), and the most common type of stroke was large artery atherosclerotic stroke (77.1%), the highest NIHSS score was in the moderate category (85.4%), the most common risk factor is hypertension (64.4%), and basal ganglia area is the most common ischemic stroke location (52.1%). There was a positive correlation between cortisol levels with NIHSS (r=0.874; p-value < 0.001), NLR with sleep disturbances (r=0.829; p-value< 0.001), NLR with NIHSS (r=0.893; p-value< 0.001), and NIHSS with PSQI (r=0.836; p-value< 0.001).Conclusion: There were a positive correlation between cortisol level, NLR level, and NIHSS score with sleep quality disturbances based on PSQI in acute ischemic stroke patients.Keywords: acute ischemic stroke, PSQI, cortisol, NIHSS, NL