Tabor Jason, La Parker, Kline Gregory, Wang Meng, Bonfield Stephan, Machan Matthew, Wynne-Edwards Katherine, Emery Carolyn, Debert Chantel
Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
J Neurotrauma. 2023 Feb;40(3-4):296-308. doi: 10.1089/neu.2022.0190. Epub 2022 Sep 21.
Increasing rates of sport-related concussion (SRC) in youth impose a significant burden on public health systems and the lives of young athletes. Accurate prediction for those likely to develop persistent post-concussion symptomology (PPCS) using a fluid biomarker, reflecting both acute injury and recovery processes, would provide the opportunity for early intervention. Cortisol, a stress hormone released through the hypothalamic-pituitary-adrenal (HPA) axis following injury, may provide a missing physiological link to clinical recovery. This cohort study investigated the change in saliva cortisol following SRC and the association between cortisol and symptom burden in pediatric ice hockey players. Further, the association between cortisol levels and medical clearance to return to play was explored. In total, cortisol samples from 233 players were included; 165 athletes (23.6% female) provided pre-injury saliva and 68 athletes (19.1% female) provided post-SRC saliva samples for cortisol analysis. Quantile (median) regressions were used to compare cortisol between pre-injury and post-SRC groups, and the association between total symptoms (/22) and symptom severity scores (/132) reported on the Sport Concussion Assessment Tool (SCAT)3/SCAT5 and post-SRC cortisol (adjusting for age, sex, history of concussion, and time from injury to sample collection). Results demonstrated significantly lower saliva cortisol in post-SRC athletes compared with the pre-injury group (β = -0.62, 95% confidence interval [CI; -1.08, -0.16], = 0.009). Post-SRC cortisol was not significantly associated with the SCAT3/SCAT5 symptom totals or symptom severity scores; however, females were found to report more symptoms (β = 6.95, 95% CI [0.35, 13.55], = 0.040) and greater symptom severity (β = 23.87, 95% CI [9.58, 38.15], = 0.002) compared with males. Exploratory time-to-event analysis revealed a point estimate suggesting a potential association between low cortisol levels and days to medical clearance to return to play. Although preliminary, these findings suggest that the HPA axis may be dysregulated post-SRC. Further, our exploratory analysis and case presentation of post-injury outliers highlight the need to further research cortisol as a prognostic biomarker to inform individualized sex-specific care after SRC.
青少年中与运动相关的脑震荡（SRC）发生率不断上升，给公共卫生系统和年轻运动员的生活带来了沉重负担。使用一种反映急性损伤和恢复过程的动态生物标志物，对那些可能出现持续性脑震荡后症状（PPCS）的人进行准确预测，将为早期干预提供机会。皮质醇是一种在受伤后通过下丘脑 - 垂体 - 肾上腺（HPA）轴释放的应激激素，可能为临床恢复提供一个缺失的生理联系。这项队列研究调查了SRC后唾液皮质醇的变化以及儿科冰球运动员中皮质醇与症状负担之间的关联。此外，还探讨了皮质醇水平与恢复比赛的医学许可之间的关联。总共纳入了233名运动员的皮质醇样本；165名运动员（23.6%为女性）提供了受伤前的唾液样本，68名运动员（19.1%为女性）提供了SRC后的唾液样本用于皮质醇分析。使用分位数（中位数）回归来比较受伤前和SRC后两组的皮质醇，以及在运动脑震荡评估工具（SCAT）3/SCAT5上报告的总症状（/22）和症状严重程度评分（/132）与SRC后皮质醇之间的关联（调整年龄、性别、脑震荡史以及从受伤到样本采集的时间）。结果显示，与受伤前组相比，SRC后运动员的唾液皮质醇显著降低（β = -0.62，95%置信区间[CI；-1.08，-0.16]，P = 0.009）。SRC后皮质醇与SCAT3/SCAT5症状总数或症状严重程度评分无显著关联；然而，发现女性报告的症状更多（β = 6.95，95% CI [0.35，13.55]，P = 0.040），且与男性相比症状严重程度更高（β = 23.87，95% CI [9.58，38.15]，P = 0.002）。探索性的事件发生时间分析显示了一个点估计值，表明低皮质醇水平与恢复比赛的医学许可天数之间可能存在关联。尽管这些发现是初步的，但表明HPA轴在SRC后可能失调。此外，我们对受伤后异常值的探索性分析和病例呈现强调了需要进一步研究皮质醇作为一种预后生物标志物，以便为SRC后的个体化性别特异性护理提供信息。
