The significance of immunosuppression and hormonal alteration in neurotraumatology.

Thirty head trauma patients receiving no steroid treatment were investigated for a period of 20 days. The patients were divided into three groups according to their Glasgow Coma Scale (GCS) scores: GCS = 4-8 and GCS = 9-13. We studied their immunological and hormonal status with special reference to the relationship among severity of trauma, immunosuppression and hormonal alteration. The immunity tests included lymphocyte transformation, lymphocyte phenotyping and delayed hypersensitivity (DH) skin tests. The hormone study consisted of serum cortisol and ACTH level determinations. The following results were obtained: (1) The entire group suffered from significant suppression in lymphocyte responses to mitogens PHA and Con A on day 1 and day 10 after injury, but later they improved; (2) There was a significant fall (P less than 0.05) in OKT3 OKT4 and active T-cell on day 10, especially in patients with GCS less than or equal to 8; (3) A significant increase in OKT8 and decrease in OKT4 was concurrently noted causing an inversion in the ratio of OKT4 to OKT8 on the 10th day (patients 0.96:1, normal 1.6:1, P less than 0.01); (4) No significant change was observed in the number of B-cells, suggesting that cell-mediated immunity may be affected earlier and more severely than antibody producing capacity; (5) Delayed hypersensitivity skin test showed a high incidence of anergy in the severe (GCS less than or equal to 8) and fetal cases. A high mortality in anergic cases was also noted; (6) Elevated ACTH and cortisol levels detected upon arrival rapidly declined to normal value at day 5. In addition, we found no correlation between the curve of serum ACTH and cortisol alteration and the biphasic suppression curve of lymphocyte transformation in later study period. These findings suggest that the severity of natural resistance impairment seems to be related to the gravity of clinical manifestations and to the serum hormonal alteration only in the initial stages. Also, we find that the development of anergy may be an index of poor prognosis.