The predictive value of catecholamines in assessing outcome in traumatic brain injury

View More View Less
  • 1 Departments of Medicine, Neurology, and Neurosurgery, and Division of Biostatistics, University of Rochester Medical Center, Rochester, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

✓ Because of the central role of the sympathetic nervous system in mediating the stress response, plasma norepinephrine (NE), epinephrine (E), and dopamine (DA) levels were measured in 61 traumatically brain-injured patients to determine whether catecholamine (CA) levels obtained within 48 hours after injury provide reliable prognostic markers of outcome. Patient outcome was determined at 1 week using the Glasgow Coma Scale (GCS) and at the time of discharge using the Glasgow Outcome Scale (GOS). Levels of NE, E, and DA correlated highly with the admission GCS score (NE: r = 0.58, p < 0.0001; E: r = 0.46, p < 0.0025; DA: r = 0.27, p < 0.04). Moreover, in the 21 patients with GCS scores of 3 or 4 on admission, NE levels predicted outcome at 1 week. All six patients with NE levels less than 900 pg/ml (normal level less than 447 pg/ml) improved to GCS scores of greater than 11, while 12 of 15 with NE values greater than 900 pg/ml remained with GCS scores of 3 to 6 or died. Levels of E and DA were not as useful. Catecholamine levels also increased significantly as the GOS score worsened. Levels of NE and E were significantly higher in patients who died or remained persistently vegetative than in those with better outcomes. In the 54 patients who survived beyond 1 week, significant correlations were present between the length of hospitalization and NE (r = 0.71, p < 0.0001) and E (r = 0.61, p < 0.0001) levels. Concentrations of NE (r = 0.61, p < 0.0004) and E (r = 0.48, p < 0.01) were also highly correlated with the duration of ventilatory assistance. Analysis of the interactions of CA levels and GCS scores, duration of ventilatory assistance, and length of hospitalization revealed that the CA's either enhanced the reliability of the GCS score or were independent predictors of outcome.

Thus, these findings indicate that alterations in circulating CA levels reflect the severity of the neurological insult and provide support for the use of CA measurements as a physiological marker of patient outcome in both the acute and chronic phases of traumatic brain injury.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1.

    Askanazi J, , Carpentier YA, & Jeevanandam M, et al: Energy expenditure, nitrogen balance, and norepinephrine excretion after injury. Surgery 89:478484, 1981 Askanazi J, Carpentier YA, Jeevanandam M, et al: Energy expenditure, nitrogen balance, and norepinephrine excretion after injury. Surgery 89:478–484, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Braakman R, , Gelpke GJ, & Habbema JDF, et al: Systematic selection of prognostic features in patients with severe head injury. Neurosurgery 6:362370, 1980 Braakman R, Gelpke GJ, Habbema JDF, et al: Systematic selection of prognostic features in patients with severe head injury. Neurosurgery 6:362–370, 1980

    • Search Google Scholar
    • Export Citation
  • 3.

    Brackett CE: Systemic complications of central nervous system trauma, in Odom GL (ed): Central Nervous System Trauma Research Status Report, 1979. Washington, DC: Public Health Service, 1979, pp 232263 Brackett CE: Systemic complications of central nervous system trauma, in Odom GL (ed): Central Nervous System Trauma Research Status Report, 1979. Washington, DC: Public Health Service, 1979, pp 232–263

    • Search Google Scholar
    • Export Citation
  • 4.

    Choi SC, , Ward JD, & Becker DP: Chart for outcome prediction in severe head injury. J Neurosurg 59:294297, 1983 Choi SC, Ward JD, Becker DP: Chart for outcome prediction in severe head injury. J Neurosurg 59:294–297, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Clifton GL, , Robertson CS, & Grossman RG: Management of the cardiovascular and metabolic responses to severe head injury, in Becker DP, & Povlishock JT (eds): Central Nervous System Trauma Status Report. Bethesda, Md: National Institute of Neurological and Communicative Disorders and Stroke, 1985, pp 139159 Clifton GL, Robertson CS, Grossman RG: Management of the cardiovascular and metabolic responses to severe head injury, in Becker DP, Povlishock JT (eds): Central Nervous System Trauma Status Report. Bethesda, Md: National Institute of Neurological and Communicative Disorders and Stroke, 1985, pp 139–159

    • Search Google Scholar
    • Export Citation
  • 6.

    Clifton GL, , Robertson CS, & Kyper K, et al: Cardiovascular response to severe head injury. J Neurosurg 59:447454, 1983 Clifton GL, Robertson CS, Kyper K, et al: Cardiovascular response to severe head injury. J Neurosurg 59:447–454, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Clifton GL, , Ziegler MG, & Grossman RG: Circulating catecholamines and sympathetic activity after head injury. Neurosurgery 8:1014, 1981 Clifton GL, Ziegler MG, Grossman RG: Circulating catecholamines and sympathetic activity after head injury. Neurosurgery 8:10–14, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Cohn JN, , Levine TB, & Olivari MT, et al: Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819823, 1984 Cohn JN, Levine TB, Olivari MT, et al: Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819–823, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Colgan FJ, , Sawa T, & Teneyck LG, et al: Protective effects of β blockade on pulmonary function when intracranial pressure is elevated. Crit Care Med 11:368372, 1983 Colgan FJ, Sawa T, Teneyck LG, et al: Protective effects of β blockade on pulmonary function when intracranial pressure is elevated. Crit Care Med 11:368–372, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Colton T: Statistics in Medicine. Boston: Little, Brown & Co, 1974 Colton T: Statistics in Medicine. Boston: Little, Brown & Co, 1974

  • 11.

    Connor RCR: Myocardial damage secondary to brain lesions. Am Heart J 78:145148, 1969 Connor RCR: Myocardial damage secondary to brain lesions. Am Heart J 78:145–148, 1969

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Cryer PE: Physiology and pathophysiology of the human sympathoadrenal neuroendocrine system. N Engl J Med 303:436444, 1980 Cryer PE: Physiology and pathophysiology of the human sympathoadrenal neuroendocrine system. N Engl J Med 303:436–444, 1980

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Fredholm BB, , Farnebo LO, & Hamberger B: Plasma catecholamines, cyclic AMP and metabolic substrates in hemorrhagic shock of the rat. The effect of adrenal demedullation and 6-OH-dopamine treatment. Acta Physiol Scand 105:481495, 1979 Fredholm BB, Farnebo LO, Hamberger B: Plasma catecholamines, cyclic AMP and metabolic substrates in hemorrhagic shock of the rat. The effect of adrenal demedullation and 6-OH-dopamine treatment. Acta Physiol Scand 105:481–495, 1979

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Fulton RL, & Jones CE: The cause of post-traumatic pulmonary insufficiency in man. Surg Gynecol Obstet 140:179186, 1975 Fulton RL, Jones CE: The cause of post-traumatic pulmonary insufficiency in man. Surg Gynecol Obstet 140:179–186, 1975

    • Search Google Scholar
    • Export Citation
  • 15.

    Gennarelli TA, , Spielman GM, & Langfitt TW, et al: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56:2632, 1982 Gennarelli TA, Spielman GM, Langfitt TW, et al: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56:26–32, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Hamill RW, , Woolf PD, & McDonald JV, et al: Catecholamines predict outcome in traumatic brain injury. Ann Neurol 21:439444, 1987 Hamill RW, Woolf PD, McDonald JV, et al: Catecholamines predict outcome in traumatic brain injury. Ann Neurol 21:439–444, 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Jachuck SJ, , Ramani PS, & Clark F, et al: Electrocardiographic abnormalities associated with raised intracranial pressure. Br Med J 1:242244, 1975 Jachuck SJ, Ramani PS, Clark F, et al: Electrocardiographic abnormalities associated with raised intracranial pressure. Br Med J 1:242–244, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 19.

    Jennett B, & Teasdale G: Management of Head Injuries. Philadelphia: FA Davis, 1981 Jennett B, Teasdale G: Management of Head Injuries. Philadelphia: FA Davis, 1981

    • Search Google Scholar
    • Export Citation
  • 20.

    Jennett B, , Teasdale G, & Braakman R, et al: Prognosis of patients with severe head injury. Neurosurgery 4:283289, 1979 Jennett B, Teasdale G, Braakman R, et al: Prognosis of patients with severe head injury. Neurosurgery 4:283–289, 1979

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Langfitt TW, , Gennarelli TA, & Obrist WD, et al: Prospects for the future in the diagnosis and management of head injury: pathophysiology, brain imaging, and population-based studies. Clin Neurosurg 29:353376, 1982 Langfitt TW, Gennarelli TA, Obrist WD, et al: Prospects for the future in the diagnosis and management of head injury: pathophysiology, brain imaging, and population-based studies. Clin Neurosurg 29:353–376, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Langfitt TW, , Weinstein JD, & Kassell NF: Cerebral vasomotor paralysis produced by intracranial hypertension. Neurology 15:622641, 1965 Langfitt TW, Weinstein JD, Kassell NF: Cerebral vasomotor paralysis produced by intracranial hypertension. Neurology 15:622–641, 1965

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    McCullagh P, & Nelder JA: Generalized Linear Models. London: Chapman and Hall, 1983, pp 127133 McCullagh P, Nelder JA: Generalized Linear Models. London: Chapman and Hall, 1983, pp 127–133

    • Search Google Scholar
    • Export Citation
  • 24.

    Neil-Dwyer G, , Walter P, & Cruickshank JM, et al: Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J 2:990992, 1978 Neil-Dwyer G, Walter P, Cruickshank JM, et al: Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J 2:990–992, 1978

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Passon PG, & Peuler JD: A simplified radiometric assay for plasma norepinephrine and epinephrine. Anal Biochem 51:618631, 1973 Passon PG, Peuler JD: A simplified radiometric assay for plasma norepinephrine and epinephrine. Anal Biochem 51:618–631, 1973

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Peuler JD, & Johnson GA: Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamine. Life Sci 21:625636, 1977 Peuler JD, Johnson GA: Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamine. Life Sci 21:625–636, 1977

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Postel J, & Schloerb PR: Metabolic effects of experimental bacteremia. Ann Surg 185:475480, 1977 Postel J, Schloerb PR: Metabolic effects of experimental bacteremia. Ann Surg 185:475–480, 1977

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Robertson CS, , Clifton GL, & Taylor AA, et al: Treatment of hypertension associated with head injury. J Neurosurg 59:455460, 1983 Robertson CS, Clifton GL, Taylor AA, et al: Treatment of hypertension associated with head injury. J Neurosurg 59:455–460, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Rosner MJ, , Newsome HH, & Becker DP: Mechanical brain injury: the sympathoadrenal response. J Neurosurg 61:7686, 1984 Rosner MJ, Newsome HH, Becker DP: Mechanical brain injury: the sympathoadrenal response. J Neurosurg 61:76–86, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Schenk EA, & Moss AJ: Cardiovascular effects of sustained norepinephrine infusions. II. Morphology. Circ Res 18:605615, 1966 Schenk EA, Moss AJ: Cardiovascular effects of sustained norepinephrine infusions. II. Morphology. Circ Res 18:605–615, 1966

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • Search Google Scholar
    • Export Citation
  • 32.

    Wilmore DW, , Long JM, & Mason AD Jr, et al: Catecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg 180:653669, 1974 Wilmore DW, Long JM, Mason AD Jr, et al: Catecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg 180:653–669, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Woolf PD, , Hamill RW, & McDonald JV, et al: Transient hypogonadotropic hypogonadism caused by critical illness. J Clin Endocrinol Metab 60:444450, 1985 Woolf PD, Hamill RW, McDonald JV, et al: Transient hypogonadotropic hypogonadism caused by critical illness. J Clin Endocrinol Metab 60:444–450, 1985

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 769 202 23
Full Text Views 248 10 0
PDF Downloads 152 13 0
EPUB Downloads 0 0 0