Association Between Serum Cortisol Levels and Clinical Outcomes in Acute Ischemic Stroke: A Prospective Observational Study

Background Acute ischemic stroke (AIS) triggers activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevated cortisol levels. Cortisol influences glucose mobilization, cardiovascular output, and metabolic responses. This study aimed to evaluate the relationship between serum cortisol levels and outcomes in patients with AIS. Methods This prospective analytical study was conducted in the Department of Internal Medicine, Sree Balaji Medical College and Hospital, Chennai, over 12 months (April 2023-March 2024). A total of 75 patients presenting with AIS within 72 hours of onset were included. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and serum cortisol levels were measured on admission. Functional outcome was evaluated using the Modified Rankin Scale (mRS) at 15 days. Statistical analysis included Student's t-test, ANOVA, Mann-Whitney test, and Pearson correlation. Results The mean age of participants was 59.2 ± 16.4 years, with a male predominance (57.3%). Common comorbidities included hypertension (37.3%), diabetes mellitus (26.7%), and coronary artery disease (34.7%). The average NIHSS score was 10.61, indicating moderate stroke severity. Elevated cortisol levels were strongly correlated with higher NIHSS and worse mRS scores. Patients with cortisol levels >690 nmol/L had more severe strokes, poorer functional outcomes, and higher mortality. Non-survivors demonstrated significantly higher mean cortisol levels (985.8 nmol/L) compared to survivors (726.5 nmol/L). Cortisol elevation also showed associations with hyperglycemia and hypercholesterolemia. Conclusion Serum cortisol is a reliable prognostic marker in AIS, closely linked to stroke severity, functional outcome, and mortality. Incorporating cortisol measurement into routine evaluation may improve prognostic accuracy and help guide management strategies for better patient care.