Cortisol evaluation during the acute phase of traumatic brain injury – a prospective study

Abstract

Background

Biochemical diagnosis of adrenal insufficiency (AI) is difficult in the context of traumatic brain injury (TBI)

Aim

to assess the frequency and predictive factors of AI in victims of TBI from Algiers.

Methods

Between November 2009 and December 2013, TBI victims had a single 8-9 a.m. serum cortisol measurement during the acute post injury period (0-7 days). AI was defined according to basal cortisol levels of 83, 276 and 414 nmol/L. Variables studied were TBI severity according to Glasgow coma scale, duration of intubation and coma, pupillary status, hypotension, anemia, brain imaging findings, diabetes insipidus and medication. Insulin tolerance test was performed during the recovery phase, defining AI as peak cortisol <500 nmol/L.

Results

Cortisol samples were obtained at median 3 (1-7) days from 277 patients (257M: 20F) aged 32 (18-65) years. Acute AI frequency was 8 (2.8%), 20 (21%) and 35 (37%) respectively using the three cortisol cut-offs. Factors predicting AI were diastolic hypotension, sedative medication, diabetes insipidus, skull base fracture and intra-parenchymal haematoma. Mortality was highest in patients with acute cortisol <276nmol/L (44.6% with OR for death 1.64, 95% CI 0.92-3.0, p=0.12). During the recovery phase, AI was present in 3/3, 12/24, 4/16 and 20/66 patients with week 1 cortisol <83, 83-276, 277-414 and >414nmol/L.

Conclusion

Hydrocortisone replacement is advised in TBI patients with morning cortisol <276 nmol/L or those <414 nmol/L with additional risk factors for AI. Since acute and subsequent AI are poorly correlated patients with moderate/severe TBI require adrenal re-evaluation during the recovery phase.

This article is protected by copyright. All rights reserved.

http://ift.tt/2GST42b