The prognostic role of cortisol and glucose dynamics in cardiogenic shock : insights from a prospective observational cohort

Abstract

Cardiogenic shock (CS) following myocardial infarction remains highly fatal. The prognostic value of dynamic metabolic markers—particularly glucose and cortisol—remains incompletely understood. In this prospective cohort study, 41 patients with infarction-related CS underwent serial blood sampling over 96 h. Plasma glucose and serum cortisol levels were measured repeatedly. Primary endpoint was in-hospital mortality. Admission glucose levels stratified as < 10, 10–15, and > 15 mmol/L were associated with rising mortality (36.4%, 43.8%, 50.0%; p = 0.47). Mortality was higher in patients without known diabetes. Early glucose normalization (≤ 6 h) correlated with improved survival (25% vs. 45%; p < 0.05). Cortisol levels were markedly elevated on admission. Survivors showed rapid decline; non-survivors had persistently high levels. Cumulative cortisol exposure (AUC₀–₉₆) was significantly lower in survivors (p = 0.016). Serial metabolic profiling identified early and sustained hyperglycaemia and hypercortisolaemia as independent predictors of mortality in infarction-related CS and potential targets for intervention.