Prognostic value of plasma hormonal disturbances in adult multi-trauma patients without traumatic brain injury. A prospective research study

Abstract

Aim

To study hormonal system disturbances in adult multiple trauma patients (MTPs) without traumatic brain injury (TBI) in the two distinctive post-traumatic phases and to reveal prognostic parameters of clinical outcome.

Method

Twenty-five MTPs were enrolled and their plasma hormone levels (PHL) measured at 24 and 72 post-traumatic hours. MTPs were ranked according to the severity scoring systems (SSS) on each post-traumatic day and all results were statistically correlated.

Results

A statistically significant (p<0.05) difference was found between GH, IGF-1, TSH, FT4, cortisol, insulin, ADH, aldosterone levels in both phases. Important positive (+) correlations in the ebb phase were seen among i) PHL of the thyroid with those of the somatotropic axis, ii) glucagon with aldosterone, ADH iii) insulin, glucagon with SAPSII score, and iv) FT4, BNP with TRISS and negative (-) among i) glucagon, aldosterone with BNP, ii) aldosterone, BNP with ISS. In the flow phase, important (+) correlations were observed among: i) cortisol, aldosterone with ACTH, ii) insulin, glucagon, C-peptide with APACHE III score and negative i) PHL of somatotropic axis with TSH and ADH, ii) ACTH, aldosterone with FT3, iii) ISS, APACHE III with FT4, and iv) insulin, C-peptide with TRISS

Conclusions

Statistical models obtained suggest that trauma impact leads to partial or complete deactivation of cellular signalling transduction membrane systems (tyrosine kinase & G-protein receptors), which is indirectly measured by the rise in the respective PHL. Early determination of insulin, glucagon, C-peptide & IFG-1 can predict clinical outcome in adult MTPs without TBI and these hormones may be incorporated into the SSS.