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Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke

Marklund, N LU ; Peltonen, M; Nilsson, T K and Olsson, T (2004) In Journal of Internal Medicine1989-01-01+01:00 256(1). p.15-21
Abstract

OBJECTIVE: Elevated cortisol levels are associated with confusion and poor outcome after stroke. Dehydroepiandrosterone sulphate (DS), the most abundant adrenal androgen may act as an anti-glucocorticoid. An altered regulation of these steroids may affect numerous brain functions, including neuronal survival. The purpose of this study was to investigate serum cortisol and DS levels and the cortisol/DS ratio early after stroke and relate our findings to the presence of disorientation and mortality.

DESIGN: Patients with acute ischaemic stroke (n = 88, 56 men and 32 women) admitted to a stroke unit were investigated with repeated clinical assessments and scores for degree of confusion, extent of paresis and level of functioning.... (More)

OBJECTIVE: Elevated cortisol levels are associated with confusion and poor outcome after stroke. Dehydroepiandrosterone sulphate (DS), the most abundant adrenal androgen may act as an anti-glucocorticoid. An altered regulation of these steroids may affect numerous brain functions, including neuronal survival. The purpose of this study was to investigate serum cortisol and DS levels and the cortisol/DS ratio early after stroke and relate our findings to the presence of disorientation and mortality.

DESIGN: Patients with acute ischaemic stroke (n = 88, 56 men and 32 women) admitted to a stroke unit were investigated with repeated clinical assessments and scores for degree of confusion, extent of paresis and level of functioning. Serum cortisol (C) and DS were measured on day 1 and/or day 4. Data for 28-day and 1-year mortality are presented. A control group of 65 age-matched healthy individuals was used. Multivariate analyses of mortality rates in the different tertiles or sixtiles of serum cortisol were performed with logistic regression, adjusting for age, sex, diabetes and level of consciousness.

RESULTS: There was no difference in serum cortisol levels on day 1 for stroke patients when compared with control group values. Initial cortisol levels were significantly higher in the patients with acute disorientation versus orientated patients (P < 0.05). Cortisol levels on day 1 were an independent predictor of 28-day mortality, and patients with low cortisol levels (<270 nmol L(-1)) and increased levels (>550 nmol L(-1)) both had an increased 1-year mortality. DS levels on day 1 were significantly elevated in stroke patients.

CONCLUSION: Hypercortisolism is associated with cognitive dysfunction early after ischaemic stroke. High and low circulating cortisol levels are associated with increased mortality after stroke. DS levels were not associated with clinical outcome.

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publishing date
type
Contribution to journal
publication status
published
keywords
Aged, Aged, 80 and over, Biomarkers, Case-Control Studies, Cognition Disorders, Dehydroepiandrosterone Sulfate, Female, Humans, Hydrocortisone, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prognosis, Stroke, Journal Article, Research Support, Non-U.S. Gov't
in
Journal of Internal Medicine1989-01-01+01:00
volume
256
issue
1
pages
7 pages
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • scopus:3042647294
ISSN
0954-6820
DOI
10.1111/j.1365-2796.2004.01334.x
language
English
LU publication?
no
id
ad95a497-5e3d-4173-9c90-c05d0bfa5f74
date added to LUP
2018-03-01 11:48:36
date last changed
2018-11-21 21:38:19
@article{ad95a497-5e3d-4173-9c90-c05d0bfa5f74,
  abstract     = {<p>OBJECTIVE: Elevated cortisol levels are associated with confusion and poor outcome after stroke. Dehydroepiandrosterone sulphate (DS), the most abundant adrenal androgen may act as an anti-glucocorticoid. An altered regulation of these steroids may affect numerous brain functions, including neuronal survival. The purpose of this study was to investigate serum cortisol and DS levels and the cortisol/DS ratio early after stroke and relate our findings to the presence of disorientation and mortality.</p><p>DESIGN: Patients with acute ischaemic stroke (n = 88, 56 men and 32 women) admitted to a stroke unit were investigated with repeated clinical assessments and scores for degree of confusion, extent of paresis and level of functioning. Serum cortisol (C) and DS were measured on day 1 and/or day 4. Data for 28-day and 1-year mortality are presented. A control group of 65 age-matched healthy individuals was used. Multivariate analyses of mortality rates in the different tertiles or sixtiles of serum cortisol were performed with logistic regression, adjusting for age, sex, diabetes and level of consciousness.</p><p>RESULTS: There was no difference in serum cortisol levels on day 1 for stroke patients when compared with control group values. Initial cortisol levels were significantly higher in the patients with acute disorientation versus orientated patients (P &lt; 0.05). Cortisol levels on day 1 were an independent predictor of 28-day mortality, and patients with low cortisol levels (&lt;270 nmol L(-1)) and increased levels (&gt;550 nmol L(-1)) both had an increased 1-year mortality. DS levels on day 1 were significantly elevated in stroke patients.</p><p>CONCLUSION: Hypercortisolism is associated with cognitive dysfunction early after ischaemic stroke. High and low circulating cortisol levels are associated with increased mortality after stroke. DS levels were not associated with clinical outcome.</p>},
  author       = {Marklund, N and Peltonen, M and Nilsson, T K and Olsson, T},
  issn         = {0954-6820},
  keyword      = {Aged,Aged, 80 and over,Biomarkers,Case-Control Studies,Cognition Disorders,Dehydroepiandrosterone Sulfate,Female,Humans,Hydrocortisone,Logistic Models,Male,Middle Aged,Multivariate Analysis,Prognosis,Stroke,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {1},
  pages        = {15--21},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine1989-01-01+01:00},
  title        = {Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke},
  url          = {http://dx.doi.org/10.1111/j.1365-2796.2004.01334.x},
  volume       = {256},
  year         = {2004},
}