SALIVARY CORTISOL LEVELS AS A PROGNOSTIC MARKER IN PATIENTS WITH ACUTE SUBARACHNOID HEMORRHAGE

Dimitar MONOV , Nikolai LILYANOV

Abstract

Introduction The stress response to aneurysmal subarachnoid hemorrhage (aSAH) has not only a beneficial effect and may become an additional cause of vasospasm. The stress response is mediated by the action of endogenous production of corticosteroids and catecholamines. The measurements of blood cortisol levels, which have been the most widely used to assess the stress response, are characterized by certain limitations. The aim of our study was to establish the relationship between the level of cortisol measured in saliva in patients with aSAH, the level of Glasgow Coma Scale (GCS) and the rate of mortality in the department of the intensive care unit (ICU). Material and Methods Our study included 78 patients with aSAH treated with endovascular embolization for cerebral aneurysm with daily examination of the level of cortisol in saliva at 08.00 AM and at 08.00 PM until ICU discharge or death. Daily salivary cortisol levels, hemodynamic parameters (mean arterial pressure), neurological status and level of consciousness (GCS) were monitored. Results Our study included 35 women and 43 men. The mean age of the patients was 64.2 years (from 42 years to 77 years). Eighteen patients died (14.06%). 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 the increase in the morning salivary cortisol level and the decrease of the score of GCS in 11 out of 18 deceased patients. The same correlation for the evening salivary cortisol was found in only 5 patients. Conclusions The measurement of salivary cortisol in patients with aSAH provides additional information about the prognosis. Patients who will die during the acute phase of aSAH have higher morning and evening salivary cortisol compared to patients who will survive. Patients who will die have demonstrated a progressive increase of the morning salivary cortisol.

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