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

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 cohor...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2020-03, Vol.105 (3), p.925-937
Main Authors: Foster, Mark A, Taylor, Angela E, Hill, Neil E, Bentley, Conor, Bishop, Jon, Gilligan, Lorna C, Shaheen, Fozia, Bion, Julian F, Fallowfield, Joanne L, Woods, David R, Bancos, Irina, Midwinter, Mark M, Lord, Janet M, Arlt, Wiebke
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - metabolism
Adult
Androgens
Clinical s
Cohort analysis
Dehydroepiandrosterone
Dehydroepiandrosterone sulfate
Drug therapy
Excretion
Gonadal Steroid Hormones - metabolism
Humans
Injury Severity Score
Male
Mass spectroscopy
Narcotics
Opioids
Patient outcomes
Patients
Pharmacology, Experimental
Prospective Studies
Rehabilitation
Sepsis
Sex hormones
Steroids (Drugs)
Supplements
Survival Rate
Testosterone
Trauma
Trauma Centers
Ultrasound
United Kingdom
Wounds and injuries
Wounds and Injuries - metabolism
Wounds and Injuries - mortality
Young Adult
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Summary: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
ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/clinem/dgz302