Stroke is the third commonest cause of mortality worldwide and a major cause of long-term disability . Stroke strongly influences an individual’s emotional and socio-economic quality of life . It is estimated that 795 000 people suffered an acute stroke in the United States of America in 2009, of whom 15–30% remain permanently disabled . An early risk assessment with an estimate of the severity of disease and prognosis is pivotal for optimized care and allocation of healthcare resources. The National Institutes of Health Stroke Scale (NIHSS) is a standardized and widely used assessment measure to predict 3-month outcome in acute cerebrovascular events but its use implies special training and there is inter-observer variability . In this context, rapidly measurable markers to predict illness development, outcome and mortality might improve the prognostic accuracy of clinical scores and traditional risk factors.
The classical ‘stress response’ of the body occurs after stimulation of the hypothalamic–pituitary axis (HPA axis) by a stressor. It is characterized by an increase in cortisol levels, depression of thyroid function and a functional deficit of anabolic hormones such as growth hormone (GH) and insulin . Anabolic resistance might contribute to the prolonged whole-body protein breakdown with increased susceptibility for infections and delayed recovery. In cerebral ischaemia, endocrine changes of the HPA axis are one of the first measurable alterations [5, 6]. In addition, low triiodothyronine (T3) levels, as in the ‘low T3 syndrome’, have been described as a prognostic risk factor for death and functional outcome in stroke patients . We therefore evaluated the prognostic value of cortisol, T3, free thyroxine (fT4), thyroid-stimulating hormone (TSH) and human GH on hospital admission in a well-described cohort of 281 patients with ischaemic stroke.