The Endocrine and Metabolic Response in Male Survivors of Major Trauma

Abstract

Background: Survival rates after severe injury are improving, but complication rates and outcomes are variable. This study addressed the lack of data on the endocrine response, particularly adrenal steroid secretion, during recovery from major trauma, exploring potential targets for intervention. Methods: We undertook a prospective, observational cohort study from time of injury to six months post-injury 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) and at regular intervals for six months. We recorded clinical outcomes (ventilator days, length of hospital stay, organ dysfunction, sepsis), measured serum steroids by tandem mass spectrometry, and assessed muscle loss by ultrasound and nitrogen excretion. Findings: We screened 996 multiply injured adults, approached 106, and recruited 95 eligible patients; 87 survived. We analysed 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 one and six weeks, respectively. Glucocorticoid secretion remained within the reference range, though the serum cortisol over cortisone ratio increased, normalising by eight weeks. Serum testosterone, DHEA and DHEAS decreased immediately after injury and took two, four and more than six months, respectively, to recover; all three correlated with SOFA score and probability of sepsis. Interpretation: The acute catabolic response to severe injury is accompanied by sustained androgen suppression. The impact of androgen supplementation on health outcomes after major trauma should be systematically explored. Funding: The SIR Study was part of the Surgeon General’s Casualty Nutrition Study (SGCNS), supported by University Hospitals Birmingham NHS Foundation Trust (UHB) and the University of Birmingham. Additional funding was provided by the Drummond Trust Foundation. Declaration of Interest: There is no conflict of interests for any of the authors. JML and WA are supported by the National Institute for Health Research (NIHR) through the NIHR Birmingham Biomedical Research Centre. Ethical Approval: Informed consent was obtained from a personal consultee and confirmed subsequently by surviving patients following recovery of capacity. The protocol was approved by the NRES Committee South West – Frenchay 11/SW/0177 and MOD REC 116/Gen/10.