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Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke.
N Marklund1, M Peltonen, T K Nilsson
1Department of Neuroscience and Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala, Sweden. niklas.marklund@neurokir.uu.se
Journal of Internal Medicine
|June 11, 2004
Summary
High cortisol levels after stroke are linked to confusion and worse outcomes. Both very high and very low cortisol levels increase mortality risk within a year, while dehydroepiandrosterone sulphate (DS) levels did not correlate with patient outcomes.
Area of Science:
- Neuroendocrinology
- Stroke Medicine
- Clinical Chemistry
Background:
- Elevated cortisol is linked to confusion and poor outcomes post-stroke.
- Dehydroepiandrosterone sulphate (DS) may possess anti-glucocorticoid properties.
- Steroid hormone dysregulation can impact brain function and neuronal survival.
Purpose of the Study:
- To investigate serum cortisol and DS levels early after ischemic stroke.
- To examine the relationship between cortisol/DS ratio and disorientation.
- To assess the association of these hormone levels with short-term and long-term mortality.
Main Methods:
- 88 acute ischemic stroke patients and 65 healthy controls were studied.
- Serum cortisol (C) and DS levels were measured on days 1 and/or 4.
- Multivariate logistic regression analyzed mortality, adjusting for clinical factors.
Main Results:
- Stroke patients showed no difference in day 1 cortisol compared to controls.
- Higher day 1 cortisol levels were associated with acute disorientation.
- Both low (<270 nmol/L) and high (>550 nmol/L) cortisol levels predicted increased 1-year mortality.
Conclusions:
- Hypercortisolism is associated with early cognitive dysfunction after ischemic stroke.
- Both high and low cortisol levels correlate with increased post-stroke mortality.
- Dehydroepiandrosterone sulphate (DS) levels were not significantly associated with clinical outcomes.