Mapping the Steroid Response to Major Trauma From Injury to Recovery: A Prospective Cohort Study

Author:

Foster Mark A12ORCID,Taylor Angela E34,Hill Neil E5,Bentley Conor12,Bishop Jon12,Gilligan Lorna C34,Shaheen Fozia34,Bion Julian F6,Fallowfield Joanne L7,Woods David R28,Bancos Irina9ORCID,Midwinter Mark M10,Lord Janet M11112,Arlt Wiebke3412

Affiliation:

1. NIHR-Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

2. Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, UK

3. Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

4. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK

5. Section of Investigative Medicine, Imperial College London, UK

6. Intensive Care Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

7. Institute of Naval Medicine, Alverstoke, Hampshire, UK

8. Leeds Beckett University, Leeds, UK

9. Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

10. School of Biomedical Sciences, University of Queensland, Brisbane, Australia

11. MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

12. NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK

Abstract

Abstract 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 <50 years not treated with steroids (N = 60; median age 27 [interquartile range 24–31] years; median NISS 34 [29–44]). Urinary nitrogen excretion and muscle loss peaked after 1 and 6 weeks, respectively. Serum testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate decreased immediately after trauma and took 2, 4, and more than 6 months, respectively, to recover; opioid treatment delayed dehydroepiandrosterone recovery in a dose-dependent fashion. Androgens and precursors correlated with SOFA score and probability of sepsis. 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.

Funder

Surgeon General’s Casualty Nutrition Study

University Hospitals Birmingham NHS Foundation Trust

University of Birmingham

National Institute for Health Research

Surgical Reconstruction and Microbiology Research Centre

Drummond Trust Foundation

NIHR Birmingham Biomedical Research Centre

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference61 articles.

1. Road safety annual report 2014;ITF.,2014

2. Changing the system – major trauma patients and their outcomes in the NHS (England) 2008-17;Moran;Eclinicalmedicine.,2018

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3