gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Activation of the pituitary hypothalamic system correlates with brain damage and outcome following traumatic brain injury

Die Aktivierung des hypophysär-hypothalamischen Systems korreliert mit der Hirnschädigung und dem Outcome nach Schädelhirnverletzungen

Meeting Abstract

  • corresponding author A. Kleindienst - Klinik für Neurochirurgie, Klinikum der Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • D. Weigel - Klinik für Neurochirurgie, Klinikum der Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • N. G. Morgenthaler - BAHMS AG, Biotechnology Centre, Research Department, Henningsdorf, Deutschland
  • G. Brabant - Christie Hospital, Department of Endocrinology, Manchester, United Kingdom
  • M. Buchfelder - Klinik für Neurochirurgie, Klinikum der Universität Erlangen-Nürnberg, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.07.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc110.shtml

Veröffentlicht: 11. April 2007

© 2007 Kleindienst et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: In traumatic brain injury (TBI), a relevant percentage of patients suffer from water and electrolyte disturbances that have been attributed to a dysregulation of the hypothalamic peptide arginine-vasopressin (AVP) system. Furthermore, AVP is involved in hemodynamic control and has been successfully implemented in cardiovascular resuscitation. Since the direct measurement of AVP concentration is difficult due to its instability, we measured copeptin, the C-terminal part of the AVP prohormone. Due to an ex vivo stability which lasts several days, copeptin can be readily assayed in serum or plasma. In this study, we tested the impact of TBI on copeptin release and on the 6-month outcome.

Methods: In 71 consecutive patients admitted for TBI (57 male, 14 female, mean age 53 years), we measured copeptin, a stable derivate of AVP, which has been demonstrated to reflect AVP activity by a sandwich immunoassay. Injury severity was assessed by the Glasgow Coma Score (GCS) and an initial CT. Copeptin and pituitary function were examined on day 0, 3 and 7, and 24 to 36 months post-injury. Recovery was assessed by the Glasgow Outcome Score (GOS) at 6 months.

Results: Copeptin was highest on admission (40.0±72.3 pmol/l), stabilized on day 3 and 7 (21.2±18.3 resp. 20.3±17.1 pmol/l) and was normalized at follow-up in all but one patient (4.2±1.7 pmol/l). The data demonstrate a significant correlation between high copeptin levels on day 3 with the GCS (r=-0.661, p<0.001), midline shift on CT (r=0.349, p=0.019), intracerebral hemorrhage (r=0.325, p=0.026), the SAPSII score (r=0.53, p=0.001), as well as with the GOS at 6 months (r=-0.302, p=0.031). Copeptin levels on day 7 were significantly decreased in patients with a skull base fracture (r=-0.357, p=0.016).

Conclusions: Our data reveal a significant predictive function of copeptin for the severity of TBI, for the acute physiological dysregulation as assessed by the SAPSII score, and even more importantly for the outcome of the patients.