创伤性脑损伤患者的皮质醇水平与严重程度、进展和生存的动态变化。
Dynamic change in cortisol levels associated with severity, progression, and survival of patients with traumatic brain injury.
机构信息
Department of Neurosurgery, King George's Medical University, Lucknow, U.P, India.
Department of Neurosurgery, King George's Medical University, Lucknow, U.P, India.
出版信息
Clin Neurol Neurosurg. 2022 Nov;222:107419. doi: 10.1016/j.clineuro.2022.107419. Epub 2022 Aug 24.
BACKGROUND
Cortisol levels are elevated in severe traumatic brain injury (TBI) and gradually decrease during patient recovery. Thus, dynamic changes in cortisol levels may serve as a prognostic biomarker of TBI.
AIM
This study aimed to examine the relationship between serum cortisol levels and outcomes in TBI patients.
METHODS
In this prospective case-cohort study, 238 patients with TBI were enrolled. Demographic, clinical, and radiological data were recorded within the first 24 h of hospitalization. Serum cortisol levels were measured using chemiluminescence assay (Immunoassay i1000). The association between cortisol levels and outcome (Glasgow Outcome Scale score) was evaluated at discharge from the hospital and after six months of follow-up.
RESULTS
The mean age of the patients was 35.03 ± 17.68 years and the male: female ratio was 4.3:1. At the time of admission(day-1), cortisol levels in the TBI patients were significantly higher than those on day-7 (9.81 ± 4.20 µg/dl versus 23.41 ± 11.83 µg/dl; p<0.001). There was a significant relationship between cortisol levels and Glasgow Coma Scale (GCS) (p = 0.018). Moderate head injury (GCS;9-12) was observed in 108(45.4 %) patients and 130(54.6 %) patients with severe head injury (GCS;3-8) at presentation. CGS was significantly associated with the survival of patients with TBI; alive(n = 143) vs. dead (n = 77); p < 0.001. At 6 months follow-up of patients (n = 184), the findings revealed that the Glasgow Outcome Scale (GOS) and GCS score were significantly associated(p = 0.018). One-way ANOVA showed a significant difference in cortisol levels on day-1, day-7 and six months of sampling (p < 0.0001). Based on the GOS E score, the cortisol levels in the unfavorable and favorable groups significantly differed from those in the GOSE groups (p = 0.05). Similarly, cortisol levels were significantly associated with survival in patients with TBI (p = 0.04). With increasing cortisol levels, the GOSE score was poor and at > 50 µg/dl, no patient has survived.
CONCLUSIONS
Day 1 and 7 cortisol, correlated with the outcomes at 6 months, had predictive value post-TBI.
背景
皮质醇水平在严重创伤性脑损伤（TBI）中升高，并在患者康复期间逐渐下降。因此，皮质醇水平的动态变化可能成为 TBI 的预后生物标志物。
目的
本研究旨在探讨 TBI 患者血清皮质醇水平与结局的关系。
方法
在这项前瞻性病例对照研究中，纳入了 238 名 TBI 患者。在住院的头 24 小时内记录了人口统计学、临床和影像学数据。使用化学发光测定法（免疫测定 i1000）测量血清皮质醇水平。在出院时和随访 6 个月时评估皮质醇水平与结局（格拉斯哥结局量表评分）之间的关系。
结果
患者的平均年龄为 35.03±17.68 岁，男女比例为 4.3:1。入院时（第 1 天），TBI 患者的皮质醇水平明显高于第 7 天（9.81±4.20µg/dl 与 23.41±11.83µg/dl；p<0.001）。皮质醇水平与格拉斯哥昏迷量表（GCS）显著相关（p=0.018）。入院时观察到中度颅脑损伤（GCS；9-12）108 例（45.4%），重度颅脑损伤（GCS；3-8）130 例（54.6%）。CGS 与 TBI 患者的生存显著相关；存活（n=143）与死亡（n=77）；p<0.001。在对患者进行 6 个月随访（n=184）时，发现格拉斯哥结局量表（GOS）和 GCS 评分与皮质醇水平显著相关（p=0.018）。单因素方差分析显示，第 1 天、第 7 天和 6 个月的皮质醇水平存在显著差异（p<0.0001）。基于 GOS E 评分，不良组和良好组的皮质醇水平与 GOSE 组有显著差异（p=0.05）。同样，皮质醇水平与 TBI 患者的生存显著相关（p=0.04）。随着皮质醇水平的升高，GOSE 评分变差，皮质醇水平>50µg/dl 时，无患者存活。
结论
第 1 天和第 7 天的皮质醇与 6 个月时的结局相关，具有 TBI 后的预测价值。
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