Prognostic value of dehydroepiandrosterone-sulfate and other parameters of adrenal function in acute ischemic stroke.

Abstract

BACKGROUND AND PURPOSE:

Acute stroke has a high morbidity and mortality. We evaluated the predictive value of adrenal function testing in acute ischemic stroke.

METHODS:

In a cohort of 231 acute ischemic stroke patients, we measured dehydroepiandrosterone (DHEA), DHEA-Sulfate (DHEAS), cortisol at baseline and 30 minutes after stimulation with 1 ug ACTH. Delta cortisol, the amount of rise in the 1 ug ACTH-test, was calculated. Primary endpoint was poor functional outcome defined as modified Rankin scale 3-6 after 1 year. Secondary endpoint was nonsurvival after 1 year.

RESULTS:

Logistic regression analysis showed that DHEAS (OR 1.21, 95% CI 1.01-1.49), but not DHEA (OR 1.01, 95% CI 0.99-1.04), was predictive for adverse functional outcome. Neither DHEA (OR 0.99, 95% CI 0.96-1.03) nor DHEAS (OR 1.10, 95% CI 0.82-1.44) were associated with mortality. Baseline and stimulated cortisol were predictive for mortality (OR 1.41, 95% CI 1.20-1.71; 1.35, 95% CI 1.15-1.60), but only basal cortisol for functional outcome (OR 1.20, 95% CI 1.04-1.38). Delta cortisol was not predictive for functional outcome (OR 0.86, 95% CI 0.71-1.05) or mortality (OR 0.92, 95% CI 0.72-1.17). The ratios cortisol/DHEA and cortisol/DHEAS discriminated between favorable outcome and nonsurvival (both p<0.0001) and between unfavorable outcome and nonsurvival (p = 0.0071 and 0.0029), but are not independent predictors for functional outcome or mortality in multivariate analysis (adjusted OR for functional outcome for both 1.0 (95% CI 0.99-1.0), adjusted OR for mortality for both 1.0 (95% CI 0.99-1.0 and 1.0-1.01, respectively)).

CONCLUSION:

DHEAS and the cortisol/DHEAS ratio predicts functional outcome 1 year after stroke whereas cortisol levels predict functional outcome and mortality.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00390962 (Retrospective analysis of this cohort).

• Authors: Claudine A Blum, Cornelia Mueller, Philipp Schuetz, Felix Fluri, Michael Trummler, Beat Mueller, Mira Katan, Mirjam Christ-Crain
• Journal: PloS one (PLoS One) Vol. 8 Issue 5 Pg. e63224 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 23650556 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dehydroepiandrosterone Sulfate
• Hydrocortisone

Topics

• Adrenal Glands (physiopathology)
• Aged
• Aged, 80 and over
• Area Under Curve
• Brain Ischemia (blood, mortality, pathology)
• Dehydroepiandrosterone Sulfate (blood)
• Female
• Humans
• Hydrocortisone (blood)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• ROC Curve
• Stroke (blood, mortality, pathology)