Salivary Cortisol Levels as a Prognostic Outcome Marker in Patients with Acute Aneurysmal Subarachnoid Haemorrhage
DOI:
https://doi.org/10.7546/CRABS.2024.11.11Keywords:
cortisol, saliva, mortality, subarachnoid haemorrhage (SAH), intensive care unit (ICU), Glasgow Coma Scale (GCS)Abstract
The physiological stress response to aneurysmal subarachnoid haemorrhage (aSAH) may trigger not only beneficial effects. Production of corticosteroids and catecholamines can induce cerebral vasospasm. Cortisol secretion levels were used to assess physiological stress. However, the appropriate measurement method remains controversial. Our study aimed to establish the relationship between cortisol levels measured in the saliva of patients with aSAH, neurological status, and mortality rates. Our study included 128 patients with aSAH treated with endovascular embolization for cerebral aneurysm with a daily examination of the cortisol level in saliva at 08.00 AM and 08.00 PM until ICU discharge or death. Daily salivary cortisol levels, haemodynamic parameters (mean arterial pressure), neurological status, and the level of consciousness (GCS) were monitored. This study included 53 women and 75 men. The mean patient age was 64.2 years (range: 42–77 years). Eighteen (14.06%) patients died. Salivary cortisol levels were significantly higher in deceased patients, both in the morning (31.8 nmol/l for deceased patients vs. 16.8 nmol/l for patients discharged alive; p < 0.001), and in the evening during the follow-up period (5.2 nmol/l for deceased patients vs. 3.6 nmol/l for patients discharged alive; p < 0.001). We found a statistically significant correlation between an increase in morning salivary cortisol levels and neurological deterioration. Similar observations of evening cortisol levels were observed in only five patients. Measurement of salivary cortisol levels in patients with aSAH provides additional information about prognosis. Patients who die during the acute phase of aSAH have higher morning and evening salivary cortisol levels than those who survive. Patients who died demonstrated a progressive increase in salivary cortisol levels in the morning.
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