TY  - JOUR
PY  - 2019//
TI  - Estradiol to androstenedione ratios moderate the relationship between neurological injury severity and mortality risk after severe TBI
JO  - Journal of neurotrauma
A1  - Ranganathan, Prerna
A1  - Kumar, Raj Gopalan
A1  - Oh, Byung-Mo
A1  - Rakholia, Milap Vrijlal
A1  - Berga, Sarah
A1  - Wagner, Amy K.
SP  - 538
EP  - 547
VL  - 36
IS  - 4
N2  - Early declines in gonadotropin production, despite elevated serum estradiol, among patients with severe traumatic brain injury (TBI) suggests amplified aromatization occurs post-injury. Our previous work identifies estradiol (E2) as a potent mortality marker. Androstenedione (Andro), a metabolic precursor to E2 and testosterone (T), is a steroid hormone, yet has not been explored in TBI. We evaluated daily serum Andro, estrone (E1), T, and E2 over the first three days post-injury for 82 subjects with severe TBI. Daily hormone values were calculated, and E2:Andro (E2:A) and E1:T ratios were generated and then averaged. After data inspection, mean E2:A values were categorized as above (high aromatization) and below (low aromatization) the 50th percentile for 30-day mortality assessment using Kaplan-Meier survival analysis and a multivariable Cox proportional hazard model adjusting for age, and Glasgow Coma Scale (GCS) to predict 30-day mortality status. Daily serum T, E1, and E2 were graphed by E2:A category. Serum E1 and E2 significantly differed over time (p<0.05); the high aromatization group had elevated levels. The high aromatization group had a significantly lower probability of survival within the first 30-days (p=0.0274). The multivariable Cox model showed a significant E2:A*GCS interaction (p=0.0129), wherein GCS predicted mortality only among those in the low aromatization group. E2:A may be a useful mortality biomarker representing enhanced aromatization after TBI. E2:A ratios represent non-neurological organ dysfunction after TBI and may be useful in defining injury subgroups in which GCS has variable capacity to serve as an accurate early prognostic marker.<p />  <p>Language: en</p>
LA  - en
SN  - 0897-7151
UR  - http://dx.doi.org/10.1089/neu.2018.5677
ID  - ref1
ER  -