23.4% Hypertonic Saline: A Tactical Option for the Management of Severe Traumatic Brain Injury With Impending or Ongoing Herniation

Relationship between Prognosis with Dynamic Changes of Thyroid Hormone and Cortisol Hormone in Patients with Severe Craniocerebral Injury

Objective

To analyze the dynamic changes of thyroid hormone and cortisol hormone (COR) and their relationship with prognosis in patients with severe craniocerebral injury.

Methods

A retrospective analysis of 48 patients with severe craniocerebral injury who were admitted to our hospital from January 2014 to January 2017 was performed. According to the Glasgow Outcome Scale (GOS) after 3 months of treatment, the patients were divided into a favorable prognosis group (GOS score = 4-5) and a poor prognosis group (GOS score = 1–3). Clinical data such as ICU hospitalization time and mechanical ventilation time between the two groups were collected and compared. The GCS score was evaluated and recorded at 24 h and 7 d after injury, respectively. The fasting venous blood was collected from patients at 24 h and 7 d after injury, and the levels of thyrotropin (TSH), total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), and free thyroxine (FT4) were detected by the time-resolved fluorescence immunoassay, while the cortisol (COR) levels were examined by the chemiluminescence assays. The prognostic risk factors of patients with severe craniocerebral injury were analyzed using logistic regression analysis. A nomogram prediction model was constructed based on the results of the logistic analysis. The value of each factor in predicting the prognosis of patients with severe craniocerebral injury was analyzed using the ROC curve.

Results

Significant differences existed between the poor prognosis group and the favorable prognosis group in age, whether complicated with a cerebral hernia, intracranial hematoma volume, admission time, ICU hospitalization time, GCS score, and mechanical ventilation time (P < 0.05). At 24 h after injury, the levels of TT4, FT3, and FT4 in the poor prognosis group were significantly lower than those in the favorable prognosis group (P < 0.05). On the 7^th day after the injury, the levels of FT3, FT4, TT3, TT4, and TSH in the poor prognosis group were prominently lower than those in the favorable prognosis group (P < 0.05). At 24 h after injury, the COR level in the poor prognosis group was observably higher than that in the favorable prognosis group (P < 0.05). Logistic regression analysis showed that age, complicated with a cerebral hernia, length of stay in ICU, FT3, FT4, TT4, and COR were the risk factors affecting the prognosis of patients with severe craniocerebral injury (P < 0.05), while the GCS score was the protective factor (P < 0.05). ROC curve analysis revealed that the area under the curve (AUC) of ICU length of stay, GCS score, FT3, and FT4 to predict the prognosis of patients with severe craniocerebral injury was better with 0.841, 0.885, 0.881, and 0.850, respectively. The survival curve drawn by the K-M method showed that high levels of serum FT3, FT4, and TT4 and low levels of COR were conducive to improve the overall survival time of patients (P < 0.05).

Conclusion

Abnormal levels of thyroid hormone and cortisol hormone were found in patients with severe craniocerebral injury. Age, combined brain herniation, ICU length of stay, FT3, FT4, TT4, COR, and GCS scores were all prognostic factors in patients with severe traumatic brain injury. These factors have high value in judging the death and survival of patients with severe craniocerebral injury.