Abstract
IntroductionThe established neuroprotective property of the sex steroid precursor dehydroepiandrosterone-sulfate (DHEAS) has not yet been investigated in the context of aneurysmal subarachnoid hemorrhage (aSAH). The influence of DHEAS on inflammatory response resulting in modulation of interleukin 6 (IL-6) synthesis has been shown. Here, we evaluate DHEAS serum levels after aSAH (day 0–14) and levels of IL-6 related to functional outcome at discharge and at six months.MethodsA complete data set (DHEAS and IL-6 serum levels for days 0, 1, 4, 7, 10 and 14 after aSAH) and outcome assessment at discharge according to modified Rankin Scale score (mRS) was available for 53 patients of the initially screened cohort (n = 109). Outcome assessment six months after aSAH was obtained from 41 patients. Logarithmized levels of DHEAS and IL-6 were related to dichotomized functional outcome either assessed at discharge or at six months. A mixed between-within subjects ANOVA was applied for statistical analysis (SPSS 21.0).ResultsDHEAS and IL-6 levels across time were related to functional outcome. Regarding outcome assessment at discharge and at six months after aSAH, DHEAS levels (transformed to square root for statistical purposes) were considerably higher in patients with favorable outcome (mRS 0–2) (p = .001; p = .020). Inversely, in patients with favorable outcome either at discharge or six months after aSAH, lower IL-6 levels (logarithmized for statistical purposes) were observed across time (both p < .001).ConclusionWe provide new evidence that DHEAS is associated with protective properties resulting in improvement of functional outcome after aSAH, possibly by influencing the inflammatory response after aSAH shown in the decreasing IL-6 serum levels. But the results for outcome six months after SAH are limited due to a high drop-out rate.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0954-1) contains supplementary material, which is available to authorized users.
Highlights
The established neuroprotective property of the sex steroid precursor dehydroepiandrosteronesulfate (DHEAS) has not yet been investigated in the context of aneurysmal subarachnoid hemorrhage
Complete datasets for outcome according to modified Rankin Scale score (mRS) 6 months after Aneurysmal subarachnoid hemorrhage (aSAH) were available for 41 patients (51 %)
Time Course of serum DHEAS levels DHEAS serum levels were assessed from day 0 to day 14 of the inpatient stay (Table 2; Fig. 2)
Summary
The established neuroprotective property of the sex steroid precursor dehydroepiandrosteronesulfate (DHEAS) has not yet been investigated in the context of aneurysmal subarachnoid hemorrhage (aSAH). The influence of DHEAS on inflammatory response resulting in modulation of interleukin 6 (IL-6) synthesis has been shown. We evaluate DHEAS serum levels after aSAH (day 0–14) and levels of IL-6 related to functional outcome at discharge and at six months. Aneurysmal subarachnoid hemorrhage (aSAH) is a severe condition. Within the central nervous system, it displays various effects contributing to neuroprotection, such as anti-inflammatory, pro-survival and anti-glucocorticoid properties [11]. Experimental and clinical studies have repeatedly reported the neuroprotective properties of DHEAS [13,14,15,16]
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