Risk factors and predictive model of adrenocortical insufficiency in patients with traumatic brain injury

doi:10.5847/wjem.j.1920-8642.2021.03.003

Abstract

Abstract:

BACKGROUND: Neuroendocrine dysfunction after traumatic brain injury (TBI) has received increased attention due to its impact on the recovery of neural function. The purpose of this study is to investigate the incidence and risk factors of adrenocortical insufficiency (AI) after TBI to reveal independent predictors and build a prediction model of AI after TBI.

METHODS: Enrolled patients were grouped into the AI and non-AI groups. Fourteen preset impact factors were recorded. Patients were regrouped according to each impact factor as a categorical variable. Univariate and multiple logistic regression analyses were performed to screen the related independent risk factors of AI after TBI and develop the predictive model.

RESULTS: A total of 108 patients were recruited, of whom 34 (31.5%) patients had AI. Nine factors (age, Glasgow Coma Scale [GCS] score on admission, mean arterial pressure [MAP], urinary volume, serum sodium level, cerebral hernia, frontal lobe contusion, diffuse axonal injury [DAI], and skull base fracture) were probably related to AI after TBI. Three factors (urinary volume [X₄], serum sodium level [X₅], and DAI [X₈]) were independent variables, based on which a prediction model was developed (logit P= -3.552+2.583X₄+2.235X₅+2.269X₈).

CONCLUSIONS: The incidence of AI after TBI is high. Factors such as age, GCS score, MAP, urinary volume, serum sodium level, cerebral hernia, frontal lobe contusion, DAI, and skull base fracture are probably related to AI after TBI. Urinary volume, serum sodium level, and DAI are the independent predictors of AI after TBI.

Key words: Adrenocortical insufficiency, Risk factor, Predictor, Traumatic brain injury

Gui-long Feng, Miao-miao Zheng, Shi-hong Yao, Yin-qi Li, Shao-jun Zhang, Wei-jing Wen, Kai Fan, Jia-li Zhang, Xiao Zhang. Risk factors and predictive model of adrenocortical insufficiency in patients with traumatic brain injury[J]. World Journal of Emergency Medicine, 2021, 12(3): 179-184.

Figures/Tables 3

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Variables	AI group (n=34)	Non-AI group (n=74)	t/χ² or Z value	P-value
Gender			0.390 (t/χ²)	0.532
Male (n=75)	25 (33.3)	50 (66.7)
Female (n=33)	9 (27.3)	24 (72.7)
Age			4.301 (t/χ²)	0.038
≥60 years (n=33)	15 (45.5)	18 (54.5)
<60 years (n=75)	19 (25.3)	56 (74.7)
Body temperature			2.363 (t/χ²)	0.124
Normal (n=83)	23 (27.7)	60 (72.3)
Abnormal (n=25)	11(44.0)	14 (56.0)
MAP			11.540 (t/χ²)	0.001
Normal (n=80)	18 (22.5)	62 (77.5)
Abnormal (n=28)	16 (57.1)	12 (42.9)
Pulse			0.764 (t/χ²)	0.382
Normal (n=76)	22 (28.9)	54 (71.1)
Abnormal (n=32)	12 (37.5)	20 (62.5)
Respiratory			1.801 (t/χ²)	0.180
Normal (n=79)	22 (27.8)	57 (72.2)
Abnormal (n=29)	12 (41.4)	17 (58.6)
Urinary volume			19.649 (t/χ²)	0.000
Normal (n=85)	18 (21.2)	67 (78.8)
Abnormal (n=23)	16 (69.6)	7 (30.4)
Serum sodium level			19.423 (t/χ²)	0.000
Normal (n=62)	9 (14.5)	53 (85.5)
Abnormal (n=46)	25 (54.3)	21 (45.7)
Cerebral hernia			7.940 (t/χ²)	0.005
No (n=82)	20 (24.4)	62 (75.6)
Yes (n=26)	14 (53.8)	12 (46.2)
Frontal lobe contusion			4.541 (t/χ²)	0.033
No (n=48)	10 (20.8)	38 (79.2)
Yes (n=60)	24 (40.0)	36 (60.0)
Cisterna ambiens hemorrhage			0.518 (t/χ²)	0.472
No (n=37)	10 (27.0)	27 (73.0)
Yes (n=71)	24 (33.8)	47 (66.2)
DAI			11.540 (t/χ²)	0.001
No (n=80)	18 (22.5)	62 (77.5)
Yes (n=28)	16 (57.1)	12 (42.9)
Skull base fracture			7.889 (t/χ²)	0.005
No (n=74)	17 (23.0)	57 (77.0)
Yes (n=34)	17 (50.0)	17 (50.0)
GCS score			-3.838 (Z)	0.000
13-15 (n=57)	9 (15.8)	48 (84.2)
9-12 (n=26)	11 (42.3)	15 (57.7)
3-8 (n=25)	14 (56.0)	11 (44.0)

Variables	Assignment description
Age (X₁)	(≥60 years)=0, (<60 years)=1
GCS (X₂)	(13-15)=0, (9-12)=1, (3-8)=2
Mean arterial pressure (X₃)	(80-110 mmHg)=0, (<80 mmHg or >110 mmHg)=1
Urinary volume (X₄)	(400-2,500 mL/d)=0, (<400 mL/d or >2,500 mL/d)=1
Serum sodium level (X₅)	(135-145 mmol/L)=0, (<135 mmol/L or >145 mmol/L)=1
Cerebral hernia (X₆)	No=0, Yes=1
Frontal lobe contusion (X₇)	No=0, Yes=1
DAI (X₈)	No=0, Yes=1
Skull base fracture (X₉)	No=0, Yes=1
AI (dependent variable)	No=0, Yes=1

Variables	β	S.E.	Wald	df	P	Exp (B)
Age	-1.172	0.640	3.356	1	0.067	0.310
Glasgow Coma Scale score	0.618	0.469	1.736	1	0.188	1.855
Mean arterial pressure	1.214	0.830	2.137	1	0.144	3.367
Urinary volume	2.583	0.807	10.241	1	0.001	13.243
Serum sodium level	2.235	0.730	9.376	1	0.002	9.349
Cerebral hernia	-0.893	0.836	1.141	1	0.285	0.409
Frontal lobe contusion	-0.411	0.699	0.345	1	0.557	0.663
Diffuse axonal injury	2.269	1.076	4.442	1	0.035	9.665
Skull base fracture	1.210	0.651	3.451	1	0.063	3.353
Constant	-3.552	0.950	13.970	1	0.000	0.029

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