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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Catecholamines as outcome markers in isolated traumatic brain injury: the COMA-TBI study

Authors: Sandro B. Rizoli, Blessing N. R. Jaja, Alex P. Di Battista, Shawn G. Rhind, Antonio Capone Neto, Leodante da Costa, Kenji Inaba, Luis Teodoro da Luz, Bartolomeu Nascimento, Adic Perez, Andrew J. Baker, Airton Leonardo de Oliveira Manoel

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Elevated catecholamine levels might be associated with unfavorable outcome after traumatic brain injury (TBI). We investigated the association between catecholamine levels in the first 24 h post-trauma and functional outcome in patients with isolated moderate-to-severe TBI.

Methods

A cohort of 174 patients who sustained isolated blunt TBI was prospectively enrolled from three Level-1 Trauma Centers. Epinephrine (Epi) and norepinephrine (NE) concentrations were measured at admission (baseline), 6, 12 and 24 h post-injury. Outcome was assessed at 6 months by the extended Glasgow Outcome Scale (GOSE) score. Fractional polynomial plots and logistic regression models (fixed and random effects) were used to study the association between catecholamine levels and outcome. Effect size was reported as the odds ratio (OR) associated with one logarithmic change in catecholamine level.

Results

At 6 months, 109 patients (62.6%) had an unfavorable outcome (GOSE 5–8 vs. 1–4), including 51 deaths (29.3%). Higher admission levels of Epi were associated with a higher risk of unfavorable outcome (OR, 2.04, 95% CI: 1.31–3.18, p = 0.002) and mortality (OR, 2.86, 95% CI: 1.62–5.01, p = 0.001). Higher admission levels of NE were associated with higher risk of unfavorable outcome (OR, 1.59, 95% CI: 1.07–2.35, p = 0.022) but not mortality (OR, 1.45, 95% CI: 0.98–2.17, p = 0.07). There was no relationship between the changes in Epi levels over time and mortality or unfavorable outcome. Changes in NE levels with time were statistically associated with a higher risk of mortality, but the changes had no relation to unfavorable outcome.

Conclusions

Elevated circulating catecholamines, especially Epi levels on hospital admission, are independently associated with functional outcome and mortality after isolated moderate-to-severe TBI.
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Metadata
Title
Catecholamines as outcome markers in isolated traumatic brain injury: the COMA-TBI study
Authors
Sandro B. Rizoli
Blessing N. R. Jaja
Alex P. Di Battista
Shawn G. Rhind
Antonio Capone Neto
Leodante da Costa
Kenji Inaba
Luis Teodoro da Luz
Bartolomeu Nascimento
Adic Perez
Andrew J. Baker
Airton Leonardo de Oliveira Manoel
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1620-6

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