title: Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neuroscience and Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala, Sweden. niklas.marklund@neurokir.uu.se
authors.forename: N
authors.initials: N
authors.lastname: Marklund
authors.forename: M
authors.initials: M
authors.lastname: Peltonen
authors.forename: T K
authors.initials: TK
authors.lastname: Nilsson
authors.forename: T
authors.initials: T
authors.lastname: Olsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000097:blood / Q000209:etiology* / Q000401:mortality; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000401:mortality
chemical_list: D015415:Biomarkers; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone