title: Evaluate the serum cortisol in patients with intracerebral hemorrhage.
abstract: OBJECTIVE
  The level of stress hormones, especially cortisol reflects stroke severity and acts as an early risk assessment of the severity of disease and prognosis. There are few neuroendocrine change and prognostic value data in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). The present study aimed to evaluate the prognostic value of cortisol in patients with acute ICH.
  
  
  METHODS
  In a prospective observational study including 61 consecutive patients with supratentorial ICH, the morning (8 a.m.) serum cortisol level and afternoon (4 p.m.) serum cortisol level were measured to determine their value to predict functional outcome and mortality within 90 days.
  
  
  RESULTS
  Cortisol levels were increased in patients with an unfavorable functional outcome as compared to patients with a favorable functional outcome within 90 days (8 a.m. p<0.001; 4 p.m. p<0.001), and in patients who died within 90 days as compared to survivors (8 a.m. p<0.001; 4 p.m. p=0.003). For functional outcome prediction, receiver-operating-characteristics revealed an area under the curve (AUC) on admission for cortisol (8 a.m.: AUC 0.86 (95% CI 0.77-1.00)), which was statistically not different from the National Institutes of Health Stroke Scale (NIHSS) (p=0.20) or ICH score (p=0.84). For mortality prediction, cortisol had an AUC of 0.87 (95% CI 0.67-1.00), which was statistically not different from the NIHSS (p=0.58) or ICH score (p=0.68).
  
  
  CONCLUSIONS
  In our small cohort of patients with acute ICH, elevated cortisol was associated with increased mortality and worse outcome. If confirmed in a larger study, the morning serum cortisol may be used as an additional prognostic factor in ICH patients.
authors.affiliation: Departent of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, PR China; Department of Neurology, Jinshan Hospital, Fudan University, Shanghai 201508, PR China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Pathology, Jinshan Hospital, Fudan University, Shanghai 201508, PR China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Ren
authors.affiliation: Department of Neurology, Jinshan Hospital, Fudan University, Shanghai 201508, PR China. Electronic address: hbzyy00@163.com.
authors.forename: Hengbing
authors.initials: H
authors.lastname: Zu
authors.affiliation: Departent of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, PR China. Electronic address: qiang_dong163@163.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; Hypothalamic–pituitary axis; Intracerebral hemorrhage