Effect of hypothalamic- pituitary- adrenal axis on prognosis of patients with traumatic brain injury

Abstract

Objective To observe the influence of hypothalamic- pituitary- adrenal(HPA) axis on the prognosis of patients with traumatic brain injury(TBI). Methods 140 cases of TBI were fallen into the following groups:mild group(26 cases), moderate group(34 cases),severe group(64 cases), and ultra severe group(16 cases).The serum cortisol was measured at 8∶00 am on the 3rd day after TBI.The dexamethasone suppression test was done to assay the stress response ability of HPA which might be injured in TBI.0.75 mg dexamethasone was taken orally or through a stomach tube at 00∶00 am of the 4th day post- TBI, and then the serum cortisol was assayed at 8∶00 am on the 4th day post-TBI.The rate of the pulmonary infection, average hospitalization days and Glasgow Outcome Scale (GOS) were recorded. Results The rate of HPA axis dysfunction was 11.6%, 35.3%, 64.1% and 81.3% in the mild group, moderate group, severe group and ultra severe group, respectively.The difference among the four subtypes of TBI was statistically significant(χ2trend= 27.432,P< 0.01). The rate of the pulmonary infection,average hospitalization days and GOS were respectively counted in different subtypes of TBI between the patients with normal and impaired HPA.The differences in the above items were significant(P< 0.05)between the same subtypes of TBI with or without HPA axis dysfunction. Conclusion HPA axis function relates to the prognosis of TBI patients. Key words: Hypothalamic-pituitary-adrenal axis; Traumatic brain injury; Prognosis