The Prognostic Role of Cortisol and Glucose Dynamics in Cardiogenic Shock-Insights from a prospective observational cohort

Background Cardiogenic shock (CS) after myocardial infarction remains associated with excessive mortality. The prognostic relevance of early metabolic markers—specifically glucose and cortisol levels—remains insufficiently defined in this high-risk population. Methods We prospectively studied 41 patients with infarction-related CS. Admission glucose and serum cortisol levels were measured within 96 hours. The primary endpoint was in-hospital mortality. Results Admission glucose levels were < 10 mmol/L in 27%, 10–15 mmol/L in 39%, and > 15 mmol/L in 34% of patients. Mortality increased stepwise across strata (36.4%, 43.8%, and 50.0%, respectively), though not statistically significant ( p  = 0.47). Patients without known diabetes had numerically higher mortality than those with diabetes (47.1% vs. 41.7%; p  = 0.72), suggesting that acute stress hyperglycemia, rather than chronic glycemic status, may drive risk. Early normalization of glucose within six hours was associated with significantly improved survival (25% vs. 45%; p  < 0.05). Cortisol levels on admission were profoundly elevated (mean: 2316.9 ± 495.7 nmol/L). Survivors exhibited a rapid decline, while non-survivors had persistently elevated levels. Cumulative cortisol exposure (AUC₀–₉₆) was significantly lower in survivors (65,476 vs. 97,988 nmol·h/L; p  = 0.016), underscoring the prognostic impact of sustained hypercortisolemia. Conclusion Elevated glucose and cortisol levels at admission independently predicted mortality in infarction-related CS. Importantly, their early normalization was associated with improved outcomes. These findings identify stress hyperglycemia and hypercortisolemia as actionable risk markers and support targeted endocrine modulation as a potential therapeutic strategy in acute circulatory failure.