title: Neuroprotective properties of dehydroepiandrosterone-sulfate and its relationship to interleukin 6 after aneurysmal subarachnoid hemorrhage: a prospective cohort study.
abstract: BACKGROUND
  The established neuroprotective property of the sex steroid precursor dehydroepiandrosterone-sulfate (DHEAS) has not yet been investigated in the context of aneurysmal subarachnoid hemorrhage (aSAH). The influence of DHEAS on inflammatory response resulting in modulation of interleukin 6 (IL-6) synthesis has been shown. Here, we evaluate DHEAS serum levels after aSAH (day 0-14) and levels of IL-6 related to functional outcome at discharge and at six months.
  
  
  METHODS
  A complete data set (DHEAS and IL-6 serum levels for days 0, 1, 4, 7, 10 and 14 after aSAH) and outcome assessment at discharge according to modified Rankin Scale score (mRS) was available for 53 patients of the initially screened cohort (n = 109). Outcome assessment six months after aSAH was obtained from 41 patients. Logarithmized levels of DHEAS and IL-6 were related to dichotomized functional outcome either assessed at discharge or at six months. A mixed between-within subjects ANOVA was applied for statistical analysis (SPSS 21.0).
  
  
  RESULTS
  DHEAS and IL-6 levels across time were related to functional outcome. Regarding outcome assessment at discharge and at six months after aSAH, DHEAS levels (transformed to square root for statistical purposes) were considerably higher in patients with favorable outcome (mRS 0-2) (p = .001; p = .020). Inversely, in patients with favorable outcome either at discharge or six months after aSAH, lower IL-6 levels (logarithmized for statistical purposes) were observed across time (both p < .001).
  
  
  CONCLUSIONS
  We provide new evidence that DHEAS is associated with protective properties resulting in improvement of functional outcome after aSAH, possibly by influencing the inflammatory response after aSAH shown in the decreasing IL-6 serum levels. But the results for outcome six months after SAH are limited due to a high drop-out rate.
authors.affiliation: Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, D-52074, Aachen, Germany. ahoellig@ukaachen.de.|Department of Anesthesiology, RWTH Aachen University, Aachen, Germany. ahoellig@ukaachen.de.
authors.forename: Anke
authors.initials: A
authors.lastname: Höllig
authors.affiliation: Department of Pediatrics, GFO Kliniken Bonn Zweigstelle St. Marien-Hospital, Bonn, Germany. thiel_miriam@web.de.
authors.forename: Miriam
authors.initials: M
authors.lastname: Thiel
authors.affiliation: Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany. Birgit.Stoffel-Wagner@ukb.uni-bonn.de.
authors.forename: Birgit
authors.initials: B
authors.lastname: Stoffel-Wagner
authors.affiliation: Department of Anesthesiology, RWTH Aachen University, Aachen, Germany. mcoburn@ukaachen.de.
authors.forename: Mark
authors.initials: M
authors.lastname: Coburn
authors.affiliation: Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, D-52074, Aachen, Germany. hclusmann@ukaachen.de.
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
mesh_terms: D015331:Cohort Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D020127:Recovery of Function; D013345:Subarachnoid Hemorrhage / Q000209:etiology*
chemical_list: D015850:Interleukin-6; D019314:Dehydroepiandrosterone Sulfate