Acute Neuroendocrine Profile in Predicting Outcomes in Severe Traumatic Brain Injury: A Study from a Tertiary Care Center in South India.

BACKGROUND

Pituitary dysfunction following severe traumatic brain injury (sTBI) is significant and may be correlated with the outcomes.

AIMS AND OBJECTIVES

This study aimed to evaluate the early changes in pituitary hormone levels after sTBI and to correlate with outcomes in terms of severity and mortality.

METHODS

This was a prospective, observational study, involving consecutive patients of 16-60 years, with sTBI (Glasgow Coma Scale GCS < 9) presenting to the hospital within 24 h of trauma. Demographic and clinical data were collected. Serum samples were collected in the morning (08-10 am) on day 1 and day 4 for cortisol, thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and prolactin (Chemiluminescence immunoassay). Outcome was assessed in terms of mortality (which included both immediate and at 3 months) and Glasgow outcome scale at 3 months.

RESULTS

54 patients were studied. Mean cortisol on day 4 was 28.5 μg/dL in alive patients and 13.7 μg/dL in patients deceased at 3 months ( < 0.001). Patients who were deceased at 3 months had significantly lower T3 on day 4 (0.973 vs 1.4 ng/dL) and lower T4 (8.1 μg/L vs 6.1 μg/dL) as compared to patients who survived ( = 0.049 and 0.005, respectively). Acute phase TSH on day 4 levels were significantly lower in patients deceased at 3 months. There was no significant difference in the prolactin levels.

CONCLUSION

Day 4 cortisol, T3, T4, and TSH correlated with the outcomes at 3 months and hence have predictive value post-sTBI.