title: Catecholamines as outcome markers in isolated traumatic brain injury: the COMA-TBI study.
abstract: BACKGROUND
  Elevated catecholamine levels might be associated with unfavorable outcome after traumatic brain injury (TBI). We investigated the association between catecholamine levels in the first 24 h post-trauma and functional outcome in patients with isolated moderate-to-severe TBI.
  
  
  METHODS
  A cohort of 174 patients who sustained isolated blunt TBI was prospectively enrolled from three Level-1 Trauma Centers. Epinephrine (Epi) and norepinephrine (NE) concentrations were measured at admission (baseline), 6, 12 and 24 h post-injury. Outcome was assessed at 6 months by the extended Glasgow Outcome Scale (GOSE) score. Fractional polynomial plots and logistic regression models (fixed and random effects) were used to study the association between catecholamine levels and outcome. Effect size was reported as the odds ratio (OR) associated with one logarithmic change in catecholamine level.
  
  
  RESULTS
  At 6 months, 109 patients (62.6%) had an unfavorable outcome (GOSE 5-8 vs. 1-4), including 51 deaths (29.3%). Higher admission levels of Epi were associated with a higher risk of unfavorable outcome (OR, 2.04, 95% CI: 1.31-3.18, p = 0.002) and mortality (OR, 2.86, 95% CI: 1.62-5.01, p = 0.001). Higher admission levels of NE were associated with higher risk of unfavorable outcome (OR, 1.59, 95% CI: 1.07-2.35, p = 0.022) but not mortality (OR, 1.45, 95% CI: 0.98-2.17, p = 0.07). There was no relationship between the changes in Epi levels over time and mortality or unfavorable outcome. Changes in NE levels with time were statistically associated with a higher risk of mortality, but the changes had no relation to unfavorable outcome.
  
  
  CONCLUSIONS
  Elevated circulating catecholamines, especially Epi levels on hospital admission, are independently associated with functional outcome and mortality after isolated moderate-to-severe TBI.
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.affiliation: Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Blessing N R
authors.initials: BN
authors.lastname: Jaja
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Di Battista
authors.affiliation: Defence Research and Development Canada (DRDC), Toronto Research Centre, Toronto, ON, Canada.
authors.forename: Shawn G
authors.initials: SG
authors.lastname: Rhind
authors.affiliation: Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, SP, 05652-900, Brazil.
authors.forename: Antonio Capone
authors.initials: AC
authors.lastname: Neto
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto., 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
authors.forename: Leodante
authors.initials: L
authors.lastname: da Costa
authors.affiliation: University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto., 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
authors.forename: Luis Teodoro
authors.initials: LT
authors.lastname: da Luz
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto., 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
authors.forename: Bartolomeu
authors.initials: B
authors.lastname: Nascimento
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto., 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
authors.forename: Adic
authors.initials: A
authors.lastname: Perez
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Institute of Medical Science, University of Toronto, Toronto, ON, Canada.|Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Baker
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. airtonleo.manoel@gmail.com.|Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. airtonleo.manoel@gmail.com.|Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. airtonleo.manoel@gmail.com.
authors.forename: Airton Leonardo
authors.identifier: http://orcid.org/0000-0002-9593-1013
authors.initials: AL
authors.lastname: de Oliveira Manoel
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000401:mortality; D002170:Canada; D002395:Catecholamines / Q000032:analysis* / Q000097:blood; D015331:Cohort Studies; D004837:Epinephrine / Q000032:analysis / Q000097:blood; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000032:analysis / Q000097:blood; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D009638:Norepinephrine; D004837:Epinephrine
keywords: Catecholamines; Epinephrine; Functional outcome; Norepinephrine; Traumatic brain injury