Cortisol levels and the severity and outcomes of acute stroke: a systematic review.
Studies in non-stroke patients have shown an association between dysregulation of the hypothalamic-pituitary-adrenal axis and morbidity and mortality. We conducted a systematic review to evaluate cortisol levels in acute stroke and their associations with outcome. We searched MEDLINE and EMBASE for articles up to April 2013 and PsychINFO for articles up to July 2013, using the keywords "cortisol" and "stroke" and associated terms or synonyms. We included studies published in peer-reviewed journals that recruited 10 or more participants and measured cortisol at least once in the first year following stroke. Data were extracted regarding cortisol levels, including changes over time and their relationship to stroke severity, and outcome. Of 11,240 abstracts, 101 full texts were obtained and 48 fulfilled our inclusion criteria. Cortisol levels were high in the first week after stroke in the majority of studies (26 studies, n = 1,340). Higher cortisol was associated with dependency (8/11 studies, n = 822), delirium (5/6 studies, n = 269) depression (3/5 studies n = 117) and mortality (8/10 studies, n = 856). Five studies adjusted for stroke severity; one found an association between higher cortisol and dependency, and three found an association between higher cortisol and mortality. Cortisol levels are high for at least 7 days after stroke. Elevated cortisol after stroke is associated with dependency, morbidity, and mortality; however, there is insufficient evidence to conclude that these relationships are independent of stroke severity.
Department of Geriatric Medicine, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK, a.j.barugh@sms.ed.ac.uk.
Amanda Jayne
AJ
Barugh
Paul
P
Gray
Susan Deborah
SD
Shenkin
Alasdair Maurice Joseph
AM
MacLullich
Gillian Elizabeth
GE
Mead
D018450:Disease Progression; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000134:cerebrospinal fluid / Q000378:metabolism / Q000652:urine; D020521:Stroke / Q000097:blood* / Q000134:cerebrospinal fluid / Q000652:urine
D006854:Hydrocortisone