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

Foster, Mark A and Taylor, Angela E and Hill, Neil E and Bentley, Conor and Bishop, Jon and Gilligan, Lorna C and Shaheen, Fozia and Bion, Julian F and Fallowfield, Joanne L and Woods, David R and Bancos, Irina and Midwinter, Mark M and Lord, Janet M and Arlt, Wiebke (2020) Mapping the Steroid Response to Major Trauma From Injury to Recovery: A Prospective Cohort Study. The Journal of clinical endocrinology and metabolism, 105 (3). ISSN 1945-7197.

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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.

Item Type: Article
Subjects: QV Pharmacology
WD Diseases and disorders of systemic, metabolic or environmental origin > WD400 Emergency medicine
Divisions: Ambulatory Care > Endocrinology
Clinical Support > Critical Care
Planned IP Care > Plastic and Reconstructive Surgery
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 28 Feb 2020 15:50
Last Modified: 28 Feb 2020 15:50
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2886

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