Observational studyThe Journal of clinical endocrinology and metabolism2020
Mapping the Steroid Response to Major Trauma From Injury to Recovery: A Prospective Cohort Study.
Observational study in The Journal of clinical endocrinology and metabolism, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- DHEA as a Biomarker of Stress: A Systematic Review and Meta-Analysis.Frontiers in psychiatry · 2021Pooled it
- Trial
- Anti-aging effects of the adrenal androgens dehydroepiandrosterone and dehydroepiandrosterone sulfate: mechanisms of action and beneficial effects in older people.Endocrine journal · 2026Review
- Oestradiol dynamics after polytrauma are linked to injury severity and adverse outcomes.Frontiers in endocrinology · 2026Article
- Testicular endocrine function recovers following Fournier's gangrene.American journal of clinical and experimental urology · 2026Article
- Hormonal response following hemorrhage after severe trauma: an observational prospective study.Critical care (London, England) · 2025Observational
- Steroid Metabolomic Signature in Term and Preterm Infants.Biomolecules · 2024Article
- A review of the role of testosterone in the care of the critically ill patient.The Southern African journal of critical care : the official journal of the Critical Care Society · 2024Review
- Androgen Drives the Expression of SARS-CoV-2 Entry Proteins in Sinonasal Tissue.Journal of clinical and translational pathology · 2023Article
- Investigating the potential of a prematurely aged immune phenotype in severely injured patients as predictor of risk of sepsis.Immunity & ageing : I & A · 2022Article
- Integration of Metabolomic and Clinical Data Improves the Prediction of Intensive Care Unit Length of Stay Following Major Traumatic Injury.Metabolites · 2021Article
- Reflecting on success in trauma research: experiences from the SGCNS and SIR studies.BMJ military health · 2021Article
- Neuroendocrine Modulation of the Immune Response after Trauma and Sepsis: Does It Influence Outcome?Journal of clinical medicine · 2020Review
- Prevention of Adrenal Crisis: Cortisol Responses to Major Stress Compared to Stress Dose Hydrocortisone Delivery.The Journal of clinical endocrinology and metabolism · 2020Article
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 3 countries.
Funding
Abstract
contextSurvival rates after severe injury are improving, but complication rates and outcomes are variable.
objectiveThis cohort study addressed the lack of longitudinal data on the steroid response to major trauma and during recovery.
designWe undertook a prospective, observational cohort study from time of injury to 6 months postinjury at a major UK trauma centre and a military rehabilitation unit, studying patients within 24 hours of major trauma (estimated New Injury Severity Score (NISS) > 15).
main outcome measuresWe measured adrenal and gonadal steroids in serum and 24-hour urine by mass spectrometry, assessed muscle loss by ultrasound and nitrogen excretion, and recorded clinical outcomes (ventilator days, length of hospital stay, opioid use, incidence of organ dysfunction, and sepsis); results were analyzed by generalized mixed-effect linear models.
findingsWe screened 996 multiple injured adults, approached 106, and recruited 95 eligible patients; 87 survived. We analyzed all male survivors <50 years not treated with steroids (N = 60; median age 27 [interquartile range 24-31] years; median NISS 34 [29-44]). Urinary nitrogen excretion and muscle loss peaked after 1 and 6 weeks, respectively. Serum testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate decreased immediately after trauma and took 2, 4, and more than 6 months, respectively, to recover; opioid treatment delayed dehydroepiandrosterone recovery in a dose-dependent fashion. Androgens and precursors correlated with SOFA score and probability of sepsis.
conclusionThe catabolic response to severe injury was accompanied by acute and sustained androgen suppression. Whether androgen supplementation improves health outcomes after major trauma requires further investigation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.