title: Cortisol dynamics are associated with electrocardiographic abnormalities following the aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Electrocardiographic (ECG) abnormalities are common following subarachnoid hemorrhage (SAH). It probably represents cardiovascular stress after SAH.
  
  
  OBJECTIVE
  The purpose of this study was to assess cortisol dynamics in relation to the ECG abnormality and disease course of SAH.
  
  
  METHODS
  The study follows a consecutive cohort of aneurysmal SAH patients, who underwent surgery within 72 hours of onset, and they were followed up for 10 days.
  
  
  METHODS
  Serum cortisols, cortisol-binding globulin (CGB), adenocorticotropic hormone were measured (between 08.00-09.00 hours) preoperatively and then on postoperative days (PODs) 2, 4, 7, and 10. Electrocardiographs (ECG) were recorded on initial assessment and after surgery on daily basis in ICU. ECG abnormalities will be followed up by measurement of cardiac troponin T to quantify the myocyte necrosis.
  
  
  METHODS
  Logistic regression analysis using commercial available software STATA 9.
  
  
  RESULTS
  A total of 44 patients (20 M and 24 F) were eligible for the cohort analysis. Average patient age is 52.02 years (52.02 ± 11.23), and 86% (6/44) arrived with World Federation of Neurosurgical Society Scale grade 3 or better. The ECG abnormality was found in 10 cases (22.7%), but the abnormal TnT (>1 μg/l) were found in eight cases, and two cases contribute to the mortality. The ECG abnormalities are significantly associated with total cortisol on day 4 (P < 0.05) and free cortisol on day 2 (P = 0.0065).
  
  
  CONCLUSIONS
  Elevated levels of morning cortisol within the first four days after surgery are associated with the ECG abnormality.
authors.affiliation: Department of Neurosurgery, Medical Faculty of Pelita Harapan University, Lippo Village Tangerang, Neuroscience Centre Siloam Hospital, Lippo Village Tangerang, Indonesia.
authors.forename: Julius
authors.initials: J
authors.lastname: July
authors.forename: Suryani
authors.initials: S
authors.lastname: As'ad
authors.forename: F X Budhianto
authors.initials: FX
authors.lastname: Suhadi
authors.forename: Andi A
authors.initials: AA
authors.lastname: Islam