Introduction: Data on the role of endogenous sex steroids in cerebrovascular disease is sparse. Our aim was to investigate the clinical relevance of circulating sex steroids in a postmenopausal acute stroke population and search for associations with disease severity and short-term outcome.
Patients and methods: We prospectively studied 302 postmenopausal female patients hospitalized for an acute stroke in two tertiary hospitals, 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). In all patients, we performed basal biochemical investigation and hormonal testing, measuring circulating estradiol, using a high sensitivity assay, as well as androgen (dehydroepiandrosterone sulfate, Δ4-androstenedione and testosterone) and sex hormone binding globulin levels.
Results: Estradiol levels were the only hormonal parameter significantly related to stroke severity on admission, as expressed by NIHSS, after correcting for confounding factors in the multivariate analysis (β0.262, P<0.001). Estradiol was an independent determinant of 1-month mortality (odds ratio (OR) with 95% confidence intervals (CI): 1.012 (1.0051.019), P 0.001), along with stroke severity and history of arterial hypertension. Estradiol levels remained an independent predictive factor of the adverse functional outcome (mRS≥4) in the multivariate analysis (OR with 95% CI: 1.011 (1.0001.021), P 0.047), along with stroke severity and hemorrhagic stroke type.
Conclusions: We found an independent association of endogenous estradiol levels with stroke severity and short-term mortality and outcome. Circulating estradiol might represent an adjunctive biomarker to identify patients at increased risk for death and disability.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.