title: Plasma Estrogen Levels Are Associated With Severity of Injury and Outcomes After Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Biochemical mediators alter cerebral perfusion and have been implicated in delayed cerebral ischemia (DCI) and poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Estrogens (estrone [E1] and estradiol [E2]) are mediators with neuroprotective properties that could play a role in DCI. This study explored associations between plasma estrogen levels and outcomes following aSAH.
  
  
  METHODS
  Plasma samples from 1-4, 4-6, and 7-10 days after hemorrhage from 99 adult aSAH patients were analyzed for estrogen levels using liquid chromatography tandem mass spectrometry. DCI was operationalized as radiographic/ultrasonic evidence of impaired cerebral blood flow accompanied by neurological deterioration. Outcomes were assessed using the Modified Rankin Scale at 3 and 12 months after hemorrhage. Statistical analysis included correlation, regression, and group-based trajectory.
  
  
  RESULTS
  Higher E1 and E2 levels were associated with higher Hunt and Hess grade (E1, p = .01; E2, p = .03), the presence of DCI (E1, p = .02; E2, p = .02), and poor 3-month outcomes (E1, p = .002; E2, p = .002). Trajectory analysis identified distinct populations over time for E1 (61% E1 high) and E2 (68% E2 high). Patients in higher trajectory groups had higher Fisher grades (E1, p = .008; E2, p = .01), more frequent DCI (E1, p = .04; E2, p = .08), and worse 3-month outcomes (E1, p = .01; E2, p = .004) than low groups.
  
  
  CONCLUSIONS
  These results provide the first clinical evidence that plasma E1 and E2 concentrations are associated with severity of injury and outcomes after aSAH.
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA ecrago@pitt.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Crago
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Paula R
authors.initials: PR
authors.lastname: Sherwood
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bender
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Balzer
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Dianxu
authors.initials: D
authors.lastname: Ren
authors.affiliation: School of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Poloyac
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002560:Cerebrovascular Circulation; D004958:Estradiol / Q000097:blood*; D004970:Estrone / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000378:metabolism* / Q000503:physiopathology*; D015599:Trauma Severity Indices
chemical_list: D015415:Biomarkers; D004970:Estrone; D004958:Estradiol
keywords: delayed cerebral ischemia; estrogen; outcomes; subarachnoid hemorrhage