全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
PLOS ONE  2013 

Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke

DOI: 10.1371/journal.pone.0072758

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background Early prediction of outcome is important for allocation of therapeutic strategies. Endocrine alterations of the hypothalamus–pituitary–axis are one of the first stress-induced alterations after cerebral ischemia. We therefore evaluated the prognostic value of serum cortisol in Chinese patients with an acute ischemic stroke. Methods In a prospective observational study, serum cortisol was measured using a solid-phase, competitive chemiluminescent enzyme immunoassay on admission in serum of 226 consecutive Chinese patients with an acute ischemic stroke. The prognostic value of serum cortisol to predict the functional outcome, mortality within 90 days, was compared with clinical variables (e.g., advanced age and the National Institutes of Health Stroke Scale [NHISS] score) and with other known predictors. Results Patients with a poor outcome and nonsurvivors had significantly increased serum cortisol levels on admission (P<0.0001, P<0.0001). There was a positive correlation between levels of cortisol and the NIHSS (r = 0.298, P<0.0001), glucose levels (r = 0.324, P<0.0001) and infarct volume (r = 0.328, P<0.0001). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio 3.44 (2.58–6.23) and 4.21 (1.89–9.24), respectively, P<0.0001 for both, adjusted for age, the NIHSS and other predictors] in patients with ischemic stroke. In receiver operating characteristic curve analysis, cortisol could improve the NIHSS score in predicting short-term functional outcome (Area under the curve [AUC] of the combined model, 0.87; 95% CI, 0.82–0.92; P = 0.01) and mortality (AUC of the combined model, 0.90; 95% CI, 0.84–0.95; P = 0.01). Conclusion Cortisol can be seen as an independent short-term prognostic marker of functional outcome and death in Chinese patients with acute ischemic stroke even after correcting confounding factors. Combined model can add significant additional predictive information to the clinical score of the NIHSS.

References

[1]  Liu L, Wang D, Wong KS, Wang Y (2011) Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke 42: 3651–3654.
[2]  Johnston SC, Mendis S, Mathers CD (2009) Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modeling. Lancet Neurol 8: 345–354.
[3]  McEwen BS (2007) Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 87: 873–904.
[4]  Fassbender K, Schmidt R, Mossner R, Daffertshofer M, Hennerici M (1994) Pattern of activation of the hypothalamic–pituitary– adrenal axis in acute stroke. Relation to acute confusional state, extent of brain damage, and clinical outcome. Stroke 25: 1105–1108.
[5]  Fiorentino L, Saxbe D, Alessi CA, Woods DL, Martin JL (2012) Diurnal cortisol and functional outcomes in post-acute rehabilitation patients. J Gerontol A Biol Sci Med Sci 67: 677–682.
[6]  O'Neill PA, Davies I, Fullerton KJ, Bennett D (1991) Stress hormone and blood glucose response following acute stroke in the elderly. Stroke 22: 842–847.
[7]  Schoorlemmer RM, Peeters GM, van Schoor NM, Lips P (2009) Relationships between cortisol level, mortality and chronic diseases in older persons. Clin Endocrinol (Oxf) 71: 779–786.
[8]  Olsson T, Marklund N, Gustafson Y, N?sman B (1992) Abnormalities at different levels of the hypothalamic – pituitary – adrenocortical axis early after stroke. Stroke 23: 1573–1576.
[9]  Zetterling M, Engstr?m BE, Hallberg L, Hillered L, Enblad P, et al. (2011) Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage. Br J Neurosurg 25: 684–692.
[10]  Feibel JH, Hardy PM, Campell RG, Goldstein MN, Joynt RJ (1977) Prognostic value of the stress response following stroke. JAMA 238: 1374–1376.
[11]  Christensen H, Boysen G, Johannesen HH (2004) Serum-cortisol reflects severity and mortality in acute stroke. J Neurol Sci 217: 175–180.
[12]  Slowik A, Turaj W, Pankiewicz J, Dziedzic T, Szermer P (2002) Hypercortisolemia in acute stroke is related to the inflammatory response. J Neurol Sc 196: 27–32.
[13]  Anne M, Juha K, Timo M, Mikko T, Olli V (2007) Neurohormonal activation in ischemic stroke: effects of acute phase disturbances on long-term mortality. Curr Neurovasc Res 4: 170–175.
[14]  Hatano S (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54: 541–553.
[15]  Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsanl WG, et al. (1989) Measurements of acute cerebral infarction: A clinical examination scale. Stroke 20: 864–870.
[16]  Kasner SE, Chalela JA, Luciano JM, Cucchiara BL, Raps EC (1999) Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke 30: 1534–1537.
[17]  Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24: 35–41.
[18]  Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337: 1521–1526.
[19]  Bonita R, Beaglehole R (1988) Recovery of motor function after stroke. Stroke 19: 1497–1500.
[20]  Sims JR, Gharai LR, Schaefer PW, Vangel M, Rosenthal ES (2009) ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology 72: 2104–2110.
[21]  Ibrahimagi? OC, Sinanovi? O, Cickusi? A, Smajlovi? D (2005) Ischemic stroke as reaction to an acute stressful event. Med Arh 59: 79–82.
[22]  Mu DL, Wang DX, Li LH, Shan GJ, Li J (2010) High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care 14: R238.
[23]  Murros K, Fogelholm R, Kettunen S, Vuorela AL (1993) Serum cortisol and outcome of ischemic brain infarction. J Neurol Sci 116: 12–17.
[24]  Parker CR Jr, Slayden SM, Azziz R, Crabbe SL, Hines GA (2000) Effects of aging on adrenal function in the human: responsiveness and sensitivity of adrenal androgens and cortisol to adrenocorticotropin in premenopausal and postmenopausal women. J Clin Endocrinol Metab 85: 48–54.
[25]  Wilkinson CW, Petrie EC, Murray SR, Colasurdo EA, Raskind MA (2001) Human glucocorticoid feedback inhibition is reduced in older individuals: evening study. J Clin Endocrinol Metab 86: 545–550.
[26]  Chrousos GP (1995) The hypothalamic– pituitary– adrenal axis and immune mediated inflammation. N Engl J Med 332: 1351–1362.
[27]  Astr?m M, Olsson T, Asplund K (1993) Different linkage of major depression to hypercortisolism early versus late after stroke: results from a 3-year longitudinal study. Stroke 24: 52–57.
[28]  Anagnostis P, Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP (2009) The pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab 94: 2692–2701.
[29]  Sapolsky RM, Pulsinelli WA (1985) Glucocorticoids potentiate ischemic injury to neurons: therapeutic implications. Science 229: 1397–1400.
[30]  Fuchs E, Flügge G (1998) Stress, glucocorticoids and structural plasticity of the hippocampus. Neurosci Biobehav Rev 23: 295–300.
[31]  Krugers HJ, Maslam S, Korf J, Jo?ls M, Holsboer F (2000) The corticosterone synthesis inhibitor metyrapone prevents hypoxia/ischemia-induced loss of synaptic function in the rat hippocampus. Stroke 31: 1162–1172.
[32]  Katan M, Elkind MS (2011) Inflammatory and neuroendocrine biomarkers of prognosis after ischemic stroke. Expert Rev Neurother 11: 225–239.
[33]  Samuels MA (2007) The brain–heart connection. Circulation 116: 77–84.
[34]  Neidert S, Katan M, Schuetz P, Fluri F, Ernst A (2011) Anterior pituitary axis hormones and outcome in acute ischaemic stroke. J Intern Med 269: 420–432.
[35]  Potocki M, Breidthardt T, Mueller A (2010) Copeptin and risk stratification in patients with acute dyspnea. Critical Care 14: R213.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133