Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding

Objective: To evaluate the local risk factors of traumatic brain injury (TBI) patients developing gastrointestinal (GI) bleeding during the early hospitalization in neurosurgery intensive care unit (NICU). Method: From September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a. m. tomeasure the concentrations of serumadrenocorticotropic hormone (ACTH), total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5. Results: Within 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group (P<0.05). The concentrations of ACTHand gastrinwerehigher in theGI bleeding positive group than in theGI bleeding negative group, (F=1.413, P=0.253) for ACTHand (F=9.371, P=0.006) for gastrin. GI bleeding had a positive correlation with gastrin concentration (r=0. 312, P<0.05) and a negative correlation with serum hemoglobin (Hb) (r=-0.420, P<0.01). The clinical incidence ofGI bleedingwas 24.39%(10/41) in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration (OR=26.643, P<0.05) and hematocrit (Hct) (OR=5.385, P<0.05). HighACTHconcentration (> 100pg/ml) increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% (9/22) and the mortality rate was 20%(2/10). Conclusions: Low Glasgow coma scale scores, low Hb, high concentrations of gastrin andACTH (> 100 pg/ml) are risk factors and can be predictive values for post-traumaticGI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.