The Prognostic Role of Cortisol and Glucose Dynamics in Cardiogenic Shock-Insights from a Prospective Observational Cohort

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.