London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 827 909 Meta-analysis and reviews Cortisol in acute stroke and associations with outcome: a systematic review. A.J. Barugh1, P Gray2, S.D. Shenkin3, A.M.J. MacLullich4, G.E. Mead5 The University of Edinburgh and NHS Lothian, Edinburgh, UNITED KINGDOM1, The Uni-versity of Edinburgh, Edinburgh, UNITED KINGDOM2, The University of Edinburgh and NHS Lothian, Edinburgh, UNITED KINGDOM3, University of Edinburgh and NHS Lothian, Edinburgh, UNITED KINGDOM4, University of Edinburgh and NHS Lothian, Edinburgh, UNITED KING-DOM5 Background- Several studies in non-stroke patients have shown an association between dysregu-lation of the Hypothalamic-Pituitary-Adrenal axis and morbidity (e.g. delirium) and mortality. We conducted a systematic review to evaluate cortisol in acute stroke and its associations with outcome. Methods- We searched MEDLINE and EMBASE for articles up to July 2012, using the keywords “cortisol” and “stroke” and their associated terms or synonyms. We included studies published in peer reviewed journals which recruited ten or more participants and measured cortisol at least once in the first year following stroke. Data were extracted regarding cortisol levels, their relationship to stroke severity, and outcome after stroke. Results-Of 8425 abstracts, 91 full texts were obtained and 42 fulfilled our inclusion criteria. The quality of included studies, based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was variable, but generally high, ranging from 6-21 out of 22, with a me-dian score of 18. The studies were heterogenous, including between 12 and 281 participants, with a range of stroke types, stroke severity and methods of cortisol measurement. There was an associa-tion between higher cortisol and dependency (eight out of eleven studies, n=822), morbidity: delir-ium, depression, infection and hypertension (eight out of eight studies, n=435) and mortality (eight out of ten studies, n=856). Only 11 (n=966), out of the 27 studies which looked at the relationship between cortisol and stroke severity found an association. After adjusting for stroke severity, one study found an association between higher cortisol and dependency, and three studies found an asso-ciation between higher cortisol and mortality. Conclusions- Elevated cortisol after stroke is associated with dependency, morbidity and mortality, but there is insufficient evidence to be certain that these relationships are independent of stroke se-verity. 910 Meta-analysis and reviews Is renal impairment associated with cerebral small vessel disease? Systematic review and me-ta- analysis. S.D.J. Makin1, F.A.B. Cook2, J.M. 5 University of Edinburgh, Edinburgh, UNITED KINGDOM1, University of Edinburgh, Edin-burgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3 Background: Small vessel disease (SVD) of the brain may be a multi system disorder also affecting other organs including the kidney. We performed a systematic review and meta-analysis to establish the correlation of renal impairment with SVD. Methods: We searched Medline and EMBASE for studies that measured microalbuminuria or esti-mated glomerular filtration rate (eGFR) in adults with cerebral SVD, (lacunar stroke, or white matter hyperintensities WMH). We extracted data on diagnosis, demographics, co-morbidities and results. Results: Of 10433 titles, we identified 11 studies of 1365 patients with lacunar stroke and 5231 with cortical stroke, and 24 studies of 16540 patients with WMH. Four measured WMH qualitatively, 12 counted silent infarcts and 10 measured WMH volume. Patients with WMH were significantly older (68v65, p<0.001). Patients with WMH had increased odds of proteinuria, (4 studies, 1668 subjects, OR 1.91, 95% CI 1.31,2.94), and eGFR <60 (8 studies, 7850 participants, OR 2.47 (95% CI 1.93-3.15) compared to patients without: this remained significant in the 3 studies (2464 subjects) that accounted for hy-pertension, age, and sex OR 1.90 (1.45-2.48). 12 studies (8359 subjects) were not included in the meta-analysis as renal function or WMH were not dichotomised; 7 found a significant correlation. Studies of WMH had a higher OR of renal impairment (2.78 v 1.89) and less heterogeneity (I2 55 v 69%) than studies which counted silent infarcts. The OR of proteinuria in lacunar versus cortical stroke(2 studies, 297 subjects) was 0.74 (95%CI 0.21,2.58), the OR of an eGFR <60 (6 studies 5686 subjects) was 1.06 (95%CI 0.66-1.73), no studies adjusted for age or hypertension. Conclusion: Our results suggest an association between WMH and renal function, implying an un-derlying multi-system disorder, but this does not exclude a powerful co-associate effect of age. Fu-ture research should ascertain other vascular risk factors, use age-matched controls, and measure WMH.
Karger_ESC London_2013
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