title: Prognostic value of dehydroepiandrosterone-sulfate and other parameters of adrenal function in acute ischemic stroke.
abstract: OBJECTIVE
  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)).
  
  
  CONCLUSIONS
  DHEAS and the cortisol/DHEAS ratio predicts functional outcome 1 year after stroke whereas cortisol levels predict functional outcome and mortality.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00390962 (Retrospective analysis of this cohort).
authors: Department of Endocrinology, Medical University Clinic, Cantonal Hospital, Aarau, Switzerland. claudine.blum@ksa.ch
authors: Claudine A
authors: CA
authors: Blum
authors: Cornelia
authors: C
authors: Mueller
authors: Philipp
authors: P
authors: Schuetz
authors: Felix
authors: F
authors: Fluri
authors: Michael
authors: M
authors: Trummler
authors: Beat
authors: B
authors: Mueller
authors: Mira
authors: M
authors: Katan
authors: Mirjam
authors: M
authors: Christ-Crain
mesh_terms: D000311:Adrenal Glands / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002545:Brain Ischemia / Q000097:blood* / Q000401:mortality / Q000473:pathology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D020521:Stroke / Q000097:blood* / Q000401:mortality / Q000473:pathology
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone
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