Research Reports - Clinical outcomes, predictors, and prevalence of anterior pituitary disorders following traumatic brain injury

Crit Care Med. 2013 Nov 15

Lauzier F, Turgeon AF, Boutin A, Shemilt M, Côté I, Lachance O, Archambault PM, Lamontagne F, Moore L, Bernard F, Gagnon C, Cook D

OBJECTIVES:: To assess the clinical outcomes, predictors, and prevalence of
anterior pituitary disorders following traumatic brain injury.
DATA SOURCES:: We searched Medline, Embase, Cochrane Registry, BIOSIS, and Trip
Database up to February 2012 and consulted bibliographies of narrative reviews
and selected articles.
STUDY SELECTION:: We included cohort, case-control, cross-sectional studies and
randomized trials enrolling at least five adults with blunt traumatic brain
injury in whom at least one anterior pituitary axis was assessed. We excluded
case series and studies in which other neurological conditions were
indistinguishable from traumatic brain injury.
DATA EXTRACTION:: Two independent reviewers selected citations, extracted data,
and assessed the risk of bias using a standardized form.
DATA SYNTHESIS:: We performed meta-analyses using random effect models and
assessed heterogeneity using the I index.
RESULTS:: We included 66 studies (5,386 patients) evaluating prevalence, 14
evaluating clinical outcomes, and 27 evaluating predictors. Thirty studies were
at low risk of bias. Anterior pituitary disorders were associated with a trend
toward increased ICU mortality (risk ratio, 1.79; 95% CI, 0.99-3.21; four
studies) and no difference in Glasgow Outcome Scale score (mean difference,
-0.45; 95% CI, -1.10 to 0.20; three studies). Age (mean difference, 3.19; 95% CI,
0.31-6.08; 19 studies), traumatic brain injury severity (risk ratio, 2.15; 95%
CI, 1.20-3.86 for patients with severe vs nonsevere traumatic brain injury; seven
studies), and skull fractures (risk ratio, 1.73; 95% CI, 1.03-2.91; six studies)
predicted anterior pituitary disorders. Over the long term, 31.6% (95% CI,
23.6-40.1%; 27 studies) of patients had at least one anterior pituitary disorder.
We observed significant heterogeneity that was not solely explained by the risk
of bias or traumatic brain injury severity.
CONCLUSIONS:: Approximately one third of traumatic brain injury patients have
persistent anterior pituitary disorder. Older age, traumatic brain injury
severity, and skull fractures predict anterior pituitary disorders, which in turn
may be associated with higher ICU mortality. Further high-quality studies are
warranted to better define the burden of anterior pituitary disorders and to
identify high-risk patients.

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