July Julius, As'ad Suryani, Suhadi Budhianto, Islam Andi Asadul
Department of Surgery Medical, Faculty of Pelita Harapan University, Neuroscience Centre, Siloam Hospital, Lippo, Village, Tangerang, Indonesia.
Asian J Neurosurg. 2011 Jul;6(2):83-7. doi: 10.4103/1793-5482.92166.
One of aneurysmal subarachnoid hemorrhage complication is delayed ischemic neurological deficits (DIND). It is postulated that cortisol dynamics might be associated with the severity of this complication.
The goal of the study is to investigate whether the peak of morning serum cortisol levels are associated with the severity of its complication during the course of the disease.
This is a prospective cohort study conducted from January 2009 to June 2011, at our institution.
The study follows a consecutive cohort of patients for 14 days after the aneurysmal subarachnoid hemorrhage. Serum cortisols, cortisol binding globulin, adenocorticotrophic hormone (ACTH) were measured pre operatively and then on post operative days (POD) 2, 4, 7, and 10. Blood was drawn to coincide with peak cortisol levels between 08.00-09.00 hours. Neurological examinations were conducted at least twice daily and patient outcome were graded according to modified Ranklin Scale. DIND was defined by a decrease in the Glasgow Coma Scale of two or more points compared to the status on POD 1.
All the results were analyzed using statistical software, Statistical Package for Social Sciences (SPSS v61; SPSS, Inc., Chicago, IL). Logistic regression analysis was used to compare the relationship between the variables.
Thirty six consecutive patients are collected, but only 28 patients (12 M and 16 F) were eligible for the cohort analysis. Average patient age is 50.75 years old (50.75±12.27), and more than 50% (15/28) arrived with World Federation of Neurologic Surgeons grade 3 or better. Elevated total cortisol levels of more than 24 mg/dl on day 2, 4, and 10 were associated with DIND, and the most significant being on day 4 (P=0.011). These patients also had a higher grade on the modified Ranklin scale of disability.
This study shows that the elevated levels of morning total cortisol in the serum are associated with the onset of DIND during the disease course, and it's also associated with bad outcomes.
动脉瘤性蛛网膜下腔出血的并发症之一是迟发性缺血性神经功能缺损（DIND）。据推测，皮质醇动态变化可能与该并发症的严重程度相关。
本研究的目的是调查疾病过程中早晨血清皮质醇水平峰值是否与其并发症的严重程度相关。
这是一项于2009年1月至2011年6月在我们机构进行的前瞻性队列研究。
该研究对动脉瘤性蛛网膜下腔出血后的患者连续随访14天。术前及术后第2、4、7和10天测量血清皮质醇、皮质醇结合球蛋白、促肾上腺皮质激素（ACTH）。在08:00 - 09:00之间采集血液以对应皮质醇水平峰值。每天至少进行两次神经学检查，并根据改良Ranklin量表对患者预后进行分级。DIND定义为格拉斯哥昏迷量表较术后第1天的状态下降两分或更多分。
所有结果均使用统计软件社会科学统计包（SPSS v61；SPSS公司，伊利诺伊州芝加哥）进行分析。采用逻辑回归分析比较变量之间的关系。
连续收集了36例患者，但只有28例患者（12例男性和16例女性）符合队列分析条件。患者平均年龄为50.75岁（50.75±12.27），超过50%（15/28）的患者入院时世界神经外科医师联合会分级为3级或更好。术后第2、4和10天总皮质醇水平升高超过24mg/dl与DIND相关，其中第4天最为显著（P = 0.011）。这些患者在改良Ranklin残疾量表上的分级也更高。
本研究表明，血清中早晨总皮质醇水平升高与疾病过程中DIND的发生相关，并且也与不良预后相关。
