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Cortisol levels and HbA1c-based glycemic variables for the assessment of stress response in acute stroke

Zhaneta Yaneva, Mihael Tsalta-Mladenov, Yana Bocheva, Kiril Hristozov, Mila Boyadzhieva


Introduction: In various acute conditions, including acute ischemic stroke (AIS), a stress response occurs, often leading to elevated blood glucose (BG) levels, the so-called stress hyperglycemia (SH). Its adequate assessment would be particularly useful in clinical practice, both for identifying high-risk patients and for therapeutic behavior.

Aim: The aim of this article is to analyze cortisol levels and glycated hemoglobin (HbA1c)-based glycemic variables as markers for assessment of stress response in AIS and to look for an association with adverse clinical outcome.

Materials and Methods: A cross-sectional study including 114 patients with AIS, stratified according to BG at admission (admBG) and the presence of diabetes mellitus (DM)—with normoglycemia, SH, previously and newly diagnosed type 2 DM was conducted. Serum cortisol levels, as well as HbA1c-based glycemic variables were evaluated according to the severity of stroke (assessed by National Institutes of Health Stroke Scale, NIHSS score) and the prevalence of fatal outcome.

Results: The SH group demonstrated the greatest AIS severity at admission, accompanied by the highest serum cortisol levels, with a significant difference in both indicators compared to the NG group (NIHSS 15.33 ± 8.39 vs.10.63 ± 6.12, p = 0.016; serum cortisol 1039 ± 668 vs. 701.7 ± 380.8 p = 0.046). Furthermore, in patients with a fatal outcome compared to survivors, we observed significantly more severe AIS (NIHSS 15.93 ± 5.31 vs. 9.72 ± 6.31, p < 0.0001), as well as higher serum cortisol levels (1060 ± 572.1 vs. 610.5 ± 284.8, p < 0.0001). In contrast to admBG, HbA1c-based glycemic variables demonstrated the highest values in the SH group. Both cortisol and glycemic variables, but not admBG, showed positive correlation with AIS severity at admission.

Conclusion: Serum cortisol levels could be useful in assessing the severity of AIS and identifying high-risk patients. HbA1c-based glycemic variables are better determinants of stress response than absolute BG values.


cortisol, HbA1c-based glycemic variables, stroke

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About The Authors

Zhaneta Yaneva
Medical University of Varna

Second Department of Internal Diseases, Faculty of Medicine

Mihael Tsalta-Mladenov
Medical University of Varna

Department of Neurology and Neuroscience, Faculty of Medicine

Yana Bocheva
Medical University of Varna

Department of Clinical Laboratory, Faculty of Medicine

Kiril Hristozov
Medical University of Varna

Second Department of Internal Diseases, Faculty of Medicine

Mila Boyadzhieva
Medical University of Varna

Second Department of Internal Diseases, Faculty of Medicine

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