Cortisol levels and the severity and outcomes of acute stroke: a systematic review

Barugh, Amanda; Gray, Paul; Shenkin, Susan D.; MacLullich, Alasdair M.J.; Mead, Gillian

doi:10.1007/s00415-013-7231-5

Cited by 110 publications

(89 citation statements)

References 66 publications

(124 reference statements)

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“…Reports by Katan and Bustamante came to the same conclusion as in our meta-analysis [46,47]. A review by Barugh found that cortisol levels should be linked to the patient dependency, morbidity and mortality but they emphasized that it is not clear whether cortisol relates to these outcomes or relates to the initial stroke severity [48]. Cortisol is a stress-related hormone, and may reflect the degree of severity of the cerebral insult and hence the neurological outcome.…”

Section: Discussionsupporting

confidence: 64%

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

Waele¹,

Hachimi-Idrissi²

2017

Cardiovasc Pharm Open Access

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Section: Discussionsupporting

confidence: 64%

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

Waele¹,

Hachimi-Idrissi²

2017

Cardiovasc Pharm Open Access

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“…Especially in ischemic stroke patients, day‐long duration of hyperglycemia had a strong association with higher risk of the outcome in the hours after acute stroke, accelerating brain damage 22. Elevation of blood glucose levels caused activation of the coagulant system, suppression of the fibrinolytic system, and production of free radicals 26, 28, 29, 30, 31. This elevation may also lead to acidosis, excitatory amino acids, and injury to the blood–brain barrier, which cause ischemic brain damage in animal models and expand ischemic lesions volumetrically 1, 23, 25, 32.…”

Section: Discussionmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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“…donia and depression in patients with cerebral infarction which express the relation between cortisol level and some of psychological symptoms [11,23]. Despite numerous studies in this field, disagreements on the effect of cortisol on the prognosis of stroke remain strong so that a systematic review which was published in 2014 showed that elevated cortisol after stroke is associated with dependency, morbidity, and mortality but, there is insufficient evidence to conclude that these relationships are independent of stroke severity [17]. Whether the increase in cortisol level is merely a result of the infarct severity or an independent factor, is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Despite above-mentioned studies, in a number of researches, no association was found between cortisol level and mortality in ischemic stroke patients [3,15,16]. According to these controversies and lack of a final conclusion [17], this study aimed to evaluate serum cortisol level and its prognostic value in patients with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 92%

Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

Iranmanesh

Sedighi

Ziaadini

2017

Zahedan J Res Med Sci

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Background: Activation of the hypothalamo-pituitary-adrenal axis has been shown in acute ischemic stroke. Some recent studies suggest that serum cortisol level may have prognostic value in patients with ischemic stroke. The aim of this study was to evaluate the prognostic value of cortisol in patients with acute ischemic stroke. Methods: In this prospective observational study, 51 patients with acute ischemic stroke were evaluated. Cardioembolic and lacunar strokes were excluded. In the first 24 hours of admission, serum cortisol level, national institutes of health stroke scale (NIHSS), diabetes and hypertension were assessed to determine their value to predict mortality within 90 days. The results were analyzed using descriptive statistics, t-test, chi-square test and logistic regression. Results: In this study, 26 patients (51%) were female and the rest were male. Serum cortisol level was normal in 37 patients (72.5%).

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Cortisol levels and the severity and outcomes of acute stroke: a systematic review

Cited by 110 publications

References 66 publications

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

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