Neuroendocrine Disturbance And Its Influence On Cognition,Behavior And Prognosis Of Patients With Chronic Disorders Of Consciousness After Brain Injury

Objective1.To investigate the incidence and patterns of neuroendocrine disturbance in patients with chronic disorders of consciousness(cDOC)and to assess the predictive value of different clinical parameters for neuroendocrine disturbance.2.To explore the correlation between neuroendocrine and cognitive function in patients with cDOC3.To explore the correlation between neuroendocrine and behavioral scale(CRS-R)in patients with cDOC.4.To explore whether neuroendocrine affects the prognosis of patients with cDOC.Patients and MethodsA total of 53 cDOC patients were eligible for clinical data collection and neuroendocrine evaluation on admission.BCI tests were performed in 20 of 53 cDOC patients to assess their cognitive function.At 6 months and 12 months after onset,cDOC patients were followed up by telephone and then GOS were given respectively.The follow-up ended in December 2019.Part I we counted the percentage and pattern of neuroendocrine disturbance in cDOC patients according to the diagnostic criteria of hormonal abnormalities.Logistic regression analysis was used to explore the risk factors of hormonalabnormalities.Part II 20 cDOC patients were divided into the good cognitive group and the poor cognitive group by BCI.Spearman correlation analysis was made to explore the relationship between BCI online accuracy and hormones in 20 cDOC patients,Spearman correlation analysis was also used to compare the correlation between each hormone level and behavioral scale(CRS-R)of cDOC patients.Followed-up patients were divided into good outcome group and poor outcome group by GOS to compare the hormone levels.Spearman correlation analysis was used to investigate the relationship between hormone and prognosis of cDOC patients.ResultsPart I There were 32 cases in 53 cases with neuroendocrine disturbance,the incidence was 60.38%.There were single hormonal abnormalities in 15 cases,the percentage was 28.30%,and more than two hormone abnormalities in 17 cases,the percentage was 32.08%.The levels of prolactin,FT4,cortisol,LH,FSH,testosterone,estradiol,ACTH,and growth hormone were abnormal in 28.3%,18.87%,13.21%,9.43%,7.55%,5.66%,5.66%,3.77%,3.77%of cases,respectively.Risk of hormonal abnormality was increased in patients with lower CRS-R score(OR=1.781,P<0.05),patients with increased intracranial pressure(OR=0.129,P<0.05)and patients with longer duration of coma(OR=1.043,P<0.05).Part II The level of GH in the good cognitive group was significantly higher in comparison with the poor cognitive group(t=2.580,P=0.048).Spearman correlation analysis showed a positive correlation between GH and BCI accuracy(r=0.703,P=0.001).ROC analysis showed that the AUC of GH and P300 for judging the cognitive value in cDOC patients were 0.952,0.810,respectively.Cortisol was positively correlated with CRS-R total score(r=0.407,P=0.003),visual score(r=0.335,P=0.014),auditory score(r=0.3055 P=0.026),and arousal score(r=0.449,P=0.001).FT3(r= 0.395,P=0.003)and FT4(r= 0.414,P=0.002)were positively correlated with arousal score.FT4(r=-0.374,P=0.006),estrogen(r=-0.438,P=0.002)and PRL(r=0.281,P=0.041)were correlated with oromotor score.At 6 and 12 months after onset,the GH level in the poor outcome group was significantly higher in comparison with the good outcome group,and the FT3 level in the good outcome group was higher in comparison with the poor outcome group.Logistic analysis showed that GH correlated with 6-months’ GOS after brain injury strongly(OR=0.145,P=0.025),FT3 correlated with 12-months’ GOS after brain injury strongly(OR=2.987,P=0.042).At 6 months after onset,FT3(r=0.321,P<0.05),FT4(r=0.306,P<0.05)were positively correlated with GOS,GH(r=-0.405,P<0.05)was negatively correlated with the GOS.At 12 months after onset,FT3(r=0.436,P<0.05)was positively correlated with GOS,and GH(r=-0.372,P<0.05)was negatively correlated with GOS.Conclusion1.Neuroendocrine disturbance was a common complication of patients with chronic disorders of consciousness after brain injury,which should be considered seriously in clinical management.2.Risks of neuroendocrine disturbance were increased in patients with lower CRS-R score,increased intracranial pressure and longer duration of coma.3.The GH level was related to cognitive function of cDOC patients.The GH and FT3 levels were the important factors for affecting prognosis of cDOC patients.4.Hormones of cDOC patients were correlated with behavioral scale(CRS-R):Cortisol was positively correlated with CRS-R total score,visual score,auditory score,and arousal score.FT3 and FT4 were positively correlated with arousal score.FT4,estrogen and PRL were correlated with oromotor score.