Background: Stroke continues to be a major cause of death and long-term disability globally, with a significant impact in India. Identifying prognostic markers early that indicate stroke severity at the time of presentation is crucial for managing treatment and predicting outcomes. Cortisol, the main stress hormone, rises after an acute stroke due to the activation of the hypothalamic–pituitary–adrenal (HPA) axis. Although high cortisol levels have been associated with metabolic issues, inflammatory responses, and poor outcomes, its role as a marker for stroke severity is not yet clearly defined. Aim and Objectives: This study aims to assess the relationship between serum cortisol levels and stroke severity as measured by the Scandinavian Stroke Scale (SSS). Materials and Methods: Conducted over a year in the Department of General Medicine at Sree Mookambika Institute of Medical Sciences kulasekharam this hospital-based observational study included fifty patients who experienced an acute stroke within 24 hours of symptom onset. Neuroimaging confirmed the stroke subtype, and the Scandinavian Stroke Scale was used to evaluate severity. Serum cortisol levels were determined at admission using a competitive immunoenzymatic colorimetric assay. Statistical analyses, including Spearman’s correlation and Student’s t-test, were employed to explore the relationships between cortisol levels, stroke severity, and pertinent clinical and laboratory parameters. Results: The study involved 50 patients with an average age over 60, comprising 32 males and 18 females. Ischemic strokes made up 76% of the cases, while 24% were hemorrhagic strokes. Hypertension emerged as the most common risk factor (40%). The average serum cortisol level was 25.04 ± 14.65 µg/dL, and the average SSS score was 33.44 ± 8.6. There was a significant inverse correlation between serum cortisol levels and SSS scores (r = −0.465, p = 0.001), suggesting higher cortisol levels in more severe strokes. Additionally, significant associations were found between cortisol levels and total cholesterol (p = 0.013) as well as leukocyte count (p = 0.042). Conclusion: Serum cortisol levels are significantly correlated with stroke severity and could serve as a straightforward, cost-effective biomarker for early risk assessment in patients with acute stroke.

Stroke, Serum cortisol, Scandinavian Stroke Scale, Prognostic marker, Inflammation