Inverse association of dehydroepiandrosterone sulfate with stroke severity and poor functional outcome in a female stroke population
T Pappa1, K Vemmos2, K Saltiki1, E Mantzou1, K Stamatelopoulos3 & M Alevizaki1
Introduction: DHEAS is among the most abundant sex steroid products of the adrenal gland. DHEAS levels have been repeatedly associated with cardiovascular disease, but data concerning cerebrovascular disease, especially in women, is lacking. In this study, we aimed to investigate the role of DHEAS in a female population suffering an acute stroke.
Patients and methods: We studied 302 consecutive female patients presenting with an acute stroke hospitalized in two tertiary Hospitals of Athens, Greece, during a time period of 2 years. A detailed medical history and physical examination were performed and risk factors for stroke were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). One month after stroke onset, the functional outcome and degree of handicap were evaluated with the modified Rankin Scale (mRS). Besides basic biochemical investigation and lipid profile testing, a hormonal panel, including DHEAS, Δ4-androstenedione, testosterone and sex-hormone binding globulin, was performed in all subjects 25 days after stroke.
Results: A significant inverse association was found between DHEAS levels and stroke severity on admission, as expressed by NIHSS (r=−0.153, P 0.01); DHEAS remained a significant determinant of stroke severity in the multivariate model (r=−0.137, P 0.02) independently of systolic blood pressure, HDL levels, atrial fibrillation and hemorrhagic stroke subtype. Δ4-androstenedione and testosterone levels were significantly associated with 1-month mortality in the univariate analysis (P 0.021 and 0.019 respectively). DHEAS levels were inversely associated with poor outcome, i.e. combined severe handicap (mRS≥4) and death, 1 month post-stroke (P 0.019), although this did not remain significant in the multivariate model.
Conclusions: DHEAS levels are significantly associated with the severity of stroke on admission and short-term functional outcome among female stroke subjects. Further studies may clarify the role of DHEAS in cerebrovascular disease and the possible underlying mechanisms.