The changes of serum cortisol and its influence on prognosis in children with traumatic brain injury

Abstract

Objective To explore the changes of serum cortisol and its influence on prognosis in children with traumatic brain injury(TBI). Methods A total of 52 children suffering from TBI hospitalized in SICU of Nanjing Children′s Hospital from June 2014 to December 2015 were analyzed.According to the glasgow coma scale(GCS), they were divided into three groups: mild injury group(19 cases, GCS≥13), moderate injury group(16 cases, 8<GCS <13), and severe injury group(17 cases, GCS≤8). We collected the data of the following clinical parameters on the 1st, 3rd, 7th day after hospitalization: the levels of serum adrenocorticotropic hormone (ACTH) and cortisol, general vital signs, pediatric critical illness score, paediatric trauma score, cycle index(mean arterial pressure), metabolic index (total protein, albumin, blood sugar), respiratory index(pH, PaO2, PaO2/FiO2), ICU length of hospital stay, the total length of hospital stay, 28 days case fatality rate. Results (1)There were significant differences in the scores of GCS, pediatric critical illness score, pediatric trauma score, heart rate, blood glucose and white blood cell count among three groups (P 0.05, respectively). (2)The levels of cortisol in children with TBI increased (24 hours) at early stage, and then gradually dropped to normal within one week.The levels of ACTH were also elevated after injury.The levels of serum ACTH and cortisol in severe and moderate injury group were significantly higher than those in the mild group[ACTH: (44.19±9.41)pg/ml, (29.91±5.49)pg/ml, (9.47±2.32)pg/ml; cortisol: (48.57±3.63) mg/dl, (40.94±2.95) mg/dl, (25.14±1.76) mg/dl], the differences were statistically significant (P 0.05). (3)There were significant differences in the duration of mechanical ventilation, duration of shock, the ICU length of hospital stay and the total length of hospital stay among the three groups(P<0.05). All of the three groups had good prognosis, and 28 d mortality was 0. Conclusion The changes of serum cortisol and ACTH will happen to children after TBI.In the acute phase, the more severe the brain injury is, the higher the serum ACTH and cortisol level shows, and the longer of the total length of hospital stay, ICU length of hospital stay, the duration of mechanical ventilation time and shock.The serum cortisol and ACTH will decrease in some children after TBI due to the organic lesion of hypothalamic-pituitary-adrenal axis. Key words: Children; Trauma; Traumatic brain injury; Cortisol,