The Impact of High Cortisol Level in Increasing Incidence of Infection Cases Among Acute Stroke Patients

Abstract

Infection in the stroke was a treatment major problem, because it determines the prognosis. In the acute phase of stroke, high level cortisol may lead to a decreased immune system and patients tend to be more susceptible to infection. The correlation of serum cortisol level among acute stroke patients with incidence of infection was not fully investigated. The aim of this study was to determine the relationship between initial serum cortisol levels and the incidence of infection in acute stroke patients. A prospective cohort study was conducted on 32 of acute stroke patients who admitted in RSUD Dr. Soetomo Surabaya during the period December 2015 to February 2016. Total of 2 cc to the venous blood within 48 hours in onset of stroke being examined of serum cortisol. During the 7 days of hospitalization, the patient was observed for signs of infection, both clinically and the investigation in accordance with the operational definition. In the infected group there were 8 people (50%) with high cortisol levels (p = 0.015; RR 15,000; 95% IK 1.583-143,171); 6 people were (50%) using urine catheter (p = 0.049; RR 6,667; 95% IK 1.067-30.085); And 6 people were (54.5%) using NGT (p = 0,035; RR 7,200; 95% IK 1.311-39,557). In multivariate analysis obtained that Odds Ratio (OR) 15,468 based on high cortisol and OR 7,469 based on NGT usage. High cortisol levels and the use of NGT had the effect on the incidence of infection in acute stroke.

Single Serum Cortisol Value as a Prognostic Marker in Acute Ischemic Stroke

“…Cortisol increases the availability of all fuel substrates such as increased glucose level and rapid mobilization of amino acids and fats from cells, making them available to various tissues and organs [ 6 ]. On the other hand, this response has been associated with ischemic neuronal injury [ 7 ], adverse cardiac effects including arrhythmias [ 8 ], and increased infections [ 9 ] contributing to increased mortality. Thus increase in cortisol levels has been linked to the severity or prognosis of AIS in various studies [ 10 , 11 ].…”

Relationship Between High Sensitivity TNF-? WITH clinical outcome During Admission In Acute Ischemic Stroke

“…2 Other problems are associated with the risk of infection in stroke patients. 3 Tumor necrosis factor alpha (TNF-α), together with other pro-inflammatory cytokines such as Interleukin-1b (IL-1b), IL-6 and IL-8, play a role in the ischemic injury of the central nervous system. Some experimental studies have shown that TNF-α has adverse effects on ischemic brain tissue.…”