Relationship between the early postoperative serum levels of pituitary hormones and the prognosis of patients with moderate and severe traumatic brain injury

DUAN Hai-feng; HUANG Ke-feng; LI Min; CUI Jie; ZHANG Hao; QIAO Kai-peng; TIAN Zhi-hua

doi:10.13798/j.issn.1009-153X.2024.10.002

Abstract：Objective To investigate the relationship between the early postoperative serum pituitary hormone levels and the prognosis of patients with moderate and severe traumatic brain injury(TBI).Methods From December 2019 to December 2022,58 patients with moderate and severe TBI were prospectively collected.Peripheral venous blood was collected before surgery and on the 1st,7th,and 14th days after surgery to measure the levels of serum pituitary hormones.Three months after the injury,the prognosis was evaluated using the GOS score,with scores of 4～5 indicating a good prognosis and 1～3 indicating a poor prognosis.Another 15 healthy individuals undergoing physical examinations were selected as the control group.Results Compared with the control group,the preoperative serum levels of adrenocorticotropic hormone(ACTH)and cortisol(COR)in TBI patients significantly increased(P<0.01),while the serum level of thyroid stimulating hormone(TSH)significantly decreased(P<0.01),and there were no significant changes in the serum levels of free triiodothyronine(FT3)and testosterone(P>0.05).After surgery,the serum levels of ACTH and COR gradually decreased(P<0.01),while the serum levels of TSH,FT3,and testosterone first decreased and then increased(P<0.05).Three months after injury,36 patients had a good prognosis and 22 patients had a poor prognosis.Correlation analysis revealed that the preoperative serum level of ACTH(r=-0.532,P<0.001),and the serum level of COR on the 1st day after surgery(r=-0.277;P=0.035)were significantly negatively correlated with the GOS score at 3 months after injury,the serum level of testosterone(r=0.290;P=0.027),the serum level of FT3(r=0.425;P=0.001),and the serum level of TSH(r=0.567;P<0.001)on the 7th day after surgery,and the serum level of testosterone on the 14th day after surgery(r=0.336;P=0.010)were significantly positively correlated with the GOS score at 3 months after injury.Conclusions In the early stage after moderate and severe TBI,the serum levels of ACTH and COR increase significantly and then gradually decline;the serum levels of TSH,FT3,and testosterone decrease significantly and then gradually rise.The serum levels of ACTH and COR are negatively correlated with the prognosis at 3 months after surgery,while the serum levels of FT3,TSH,and testosterone are positively correlated with the prognosis at 3 months after surgery.Our results indicate that the early postoperative serum levels of ACTH,COR,FT3,TSH,and testosterone in patients with moderate and severe TBI have a certain relationship with the prognosis and can be used as indicators for judging and evaluating the prognosis of patients with moderate and severe TBI,providing a reference for timely hormone supplementation.