학술논문
Mapping the Steroid Response to Major Trauma From Injury to Recovery: A Prospective Cohort Study
CLINICAL RESEARCH ARTICLE
CLINICAL RESEARCH ARTICLE
Document Type
Report
Author
Source
Journal of Clinical Endocrinology & Metabolism. March 2020, Vol. 105 Issue 3, p925, 13 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Over 5 million people worldwide die each year from serious injury (1), with almost 25% caused by road traffic collisions (RTC) (2). In England alone, there are 5400 trauma deaths [...]
Context: Survival rates after severe injury are improving, but complication rates and outcomes are variable. Objective: This cohort study addressed the lack of longitudinal data on the steroid response to major trauma and during recovery. Design: We undertook a prospective, observational cohort study from time of injury to 6 months postinjury at a major UK trauma centre and a military rehabilitation unit, studying patients within 24 hours of major trauma (estimated New Injury Severity Score (NISS) > 15). Main outcome measures: We measured adrenal and gonadal steroids in serum and 24-hour urine by mass spectrometry, assessed muscle loss by ultrasound and nitrogen excretion, and recorded clinical outcomes (ventilator days, length of hospital stay, opioid use, incidence of organ dysfunction, and sepsis); results were analyzed by generalized mixed-effect linear models. Findings: We screened 996 multiple injured adults, approached 106, and recruited 95 eligible patients; 87 survived. We analyzed all male survivors Conclusion: The catabolic response to severe injury was accompanied by acute and sustained androgen suppression. Whether androgen supplementation improves health outcomes after major trauma requires further investigation. (J Clin Endocrinol Metab 105: 925-937, 2020) Key Words: major trauma, systemic infammatory response syndrome, stress response, steroids, DHEA, testosterone
Context: Survival rates after severe injury are improving, but complication rates and outcomes are variable. Objective: This cohort study addressed the lack of longitudinal data on the steroid response to major trauma and during recovery. Design: We undertook a prospective, observational cohort study from time of injury to 6 months postinjury at a major UK trauma centre and a military rehabilitation unit, studying patients within 24 hours of major trauma (estimated New Injury Severity Score (NISS) > 15). Main outcome measures: We measured adrenal and gonadal steroids in serum and 24-hour urine by mass spectrometry, assessed muscle loss by ultrasound and nitrogen excretion, and recorded clinical outcomes (ventilator days, length of hospital stay, opioid use, incidence of organ dysfunction, and sepsis); results were analyzed by generalized mixed-effect linear models. Findings: We screened 996 multiple injured adults, approached 106, and recruited 95 eligible patients; 87 survived. We analyzed all male survivors Conclusion: The catabolic response to severe injury was accompanied by acute and sustained androgen suppression. Whether androgen supplementation improves health outcomes after major trauma requires further investigation. (J Clin Endocrinol Metab 105: 925-937, 2020) Key Words: major trauma, systemic infammatory response syndrome, stress response, steroids, DHEA, testosterone