The ultra-acute steroid response to traumatic injury: a cohort study.

Conor Bentley, Jon Hazeldine, Laura Bravo, Angela E Taylor, Lorna C Gilligan, Fozia Shaheen, Animesh Acharjee, George Gkoutos, Mark A Foster, Wiebke Arlt, Janet M Lord

Journal: European journal of endocrinology 2023;188(3):lvad024

PMID: 36809311

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Abstract

OBJECTIVE

Trauma-induced steroid changes have been studied post-hospital admission, resulting in a lack of understanding of the speed and extent of the immediate endocrine response to injury. The Golden Hour study was designed to capture the ultra-acute response to traumatic injury.

DESIGN

We conducted an observational cohort study including adult male trauma patients <60 years, with blood samples drawn ≤1 h of major trauma by pre-hospital emergency responders.

METHODS

We recruited 31 adult male trauma patients (mean age 28 [range 19-59] years) with a mean injury severity score (ISS) of 16 (IQR 10-21). The median time to first sample was 35 (range 14-56) min, with follow-up samples collected 4-12 and 48-72 h post-injury. Serum steroids in patients and age- and sex-matched healthy controls (HCs) (n = 34) were analysed by tandem mass spectrometry.

RESULTS

Within 1 h of injury, we observed an increase in glucocorticoid and adrenal androgen biosynthesis. Cortisol and 11-hydroxyandrostendione increased rapidly, whilst cortisone and 11-ketoandrostenedione decreased, reflective of increased cortisol and 11-oxygenated androgen precursor biosynthesis by 11β-hydroxylase and increased cortisol activation by 11β-hydroxysteroid dehydrogenase type 1. Active classic gonadal androgens testosterone and 5α-dihydrotestosterone decreased, whilst the active 11-oxygenated androgen 11-ketotestosterone maintained pre-injury levels.

CONCLUSIONS

Changes in steroid biosynthesis and metabolism occur within minutes of traumatic injury. Studies that address whether ultra-early changes in steroid metabolism are associated with patient outcomes are now required.

Address: Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom.; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Cancer and Genomic Sciences, Centre for Computational Biology, University of Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Cancer and Genomic Sciences, Centre for Computational Biology, University of Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Cancer and Genomic Sciences, Centre for Computational Biology, University of Birmingham, Birmingham B15 2TT, United Kingdom.; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom.; Medical Research Council Health Data Research UK (HDR), United Kingdom.; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom.; Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ, United Kingdom.; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom.; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom.; National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom.

DOI: 10.1093/ejendo/lvad024

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MeSH Terms: Adult, Humans, Male, Young Adult, Middle Aged, Androgens, Hydrocortisone, Cohort Studies, Steroids, Dihydrotestosterone