Prognostic Value of Dehydroepiandrosterone-Sulfate and Other Parameters of Adrenal Function in Acute Ischemic Stroke

Abstract

Background and PurposeAcute stroke has a high morbidity and mortality. We evaluated the predictive value of adrenal function testing in acute ischemic stroke. MethodsIn 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.ResultsLogistic 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)).ConclusionDHEAS and the cortisol/DHEAS ratio predicts functional outcome 1 year after stroke whereas cortisol levels predict functional outcome and mortality.Trial RegistrationClinicalTrials.gov NCT00390962 (Retrospective analysis of this cohort).

Prognostic Value of Dehydroepiandrosterone Sulfate for Patients With Cardiovascular Disease: A Systematic Review and Meta‐Analysis

“…Eleven were excluded based on study design. Overall, 25 cohort studies, with a total of 92 489 CVD patients, were included in our systematic review . For each of these studies, we extracted items including year of publication, name of the first author, country of origin of the research group, sample number of studies included, design used in the studies, quality evaluation of the studies, follow‐up time, confounder for adjustments, DHEAS concentration gradient, and end point.…”

“…Six studies investigated deficient DHEAS level and fatal cardiovascular events, 7 studies investigated low DHEAS and nonfatal cardiovascular events, and 1 study reported DHEAS with fatal/nonfatal cardiovascular events separately. In the meta‐analysis, the pooled estimates for the lowest compared with the highest category of baseline DHEAS indicated a significant increased risk for fatal cardiovascular events without heterogeneity ( I 2 =0%): pooled risk ratio, 1.58 (95% CI, 1.30–1.91; P <0.00001 [Figure ]).…”

“…As both cortisol and DHEAS are synthesized within the adrenal cortex, and it is conceivable that their respective relative contributions to adrenal steroid output might define observed biological action. Furthermore, the cortisol to DHEAS ratio has been found to predict health outcomes better than the level of either hormone alone and in aging, Alzheimer's disease, metabolic syndrome, and all‐cause mortality (ACM) . By far, the strongest associations with the metabolic syndrome were observed in the cortisol/DHEAS ratio by Phillips et al .…”

Adrenal Steroids Modulate the Immune Response during Brucella abortus Infection by a Mechanism That Depends on the Regulation of Cytokine Production

“…The physiological role of DHEA is poorly understood, but there are clear indications that it modulates the immune response and influences both pro-and anti-inflammatory cytokine release (51)(52)(53)(54).…”

Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

“…It should be noted that this increase was not only observed in the blood, but also in urine and saliva [5,25]. The etiology of increase cortisol level in ischemic stroke is not obvious and some studies claim that ischemic stroke acts like a stressor and activates pituitary -adrenal axis [5,26]. This finding is also seen in intracerebral hemorrhage [14,27].…”