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March 2014

Mortality in Patients With Traumatic Brain Injury

Author Affiliations
  • 1Department of Psychiatry Administration, University of Iowa, Iowa City
JAMA Psychiatry. 2014;71(3):234-235. doi:10.1001/jamapsychiatry.2013.4241

The current issue of JAMA Psychiatry includes an important article on premature mortality among patients with traumatic brain injury (TBI) in Sweden between 1969 and 2009.1 According to the study by Fazel et al,1 among 218 300 patients with a TBI compared with age- and sex-matched controls without brain injury (10 to 1 match, n = 2 163 190) and unaffected siblings of TBI patients (n = 150 513), there was a 3-fold increased odds of all-cause mortality, adjusted for sociodemographic confounders (adjusted odds ratio [aOR], 3.2; 95% CI, 3.0-3.4), among patients who survived at least 6 months after TBI compared with general population controls or unaffected siblings (aOR, 2.6; 95% CI, 2.3-2.8). The increased rates of mortality were related to injury (aOR, 4.3; 95% CI, 3.8-4.8), assault (aOR, 3.9; 95% CI, 2.7-5.7), or suicide (aOR, 3.3; 95% CI, 2.9-3.7).

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    1 Comment for this article
    Increased deaths may partly be hormonally mediated
    Nancy Elaine Broskie MD | Affiliate Assistant Professor Psychiatry OHSU
    The pituitary is injured with the rest of the brain in TBI and likely has a higher chance of failure or insufficiency. Not making growth hormone increases the risk of death from lipids, inflammation, hypoglycemia and possibly decreased cognition secondary to those hormonal changes. (It may be why the studies with shorter folks show increased death rates in the hospital partly). However diagnosis of growth hormone deficiency can be confusing and expensive. And to make diagnosis more difficult for growth hormone deficiency, growth hormone (with a screening IGF-I often of less than 70pg/ml) increases insulin resistance, and insulin resistance decreases growth hormone, a huge confounder. Other pituitary failure (such as diminished ability to make TSH which could lead to high trigylcerides) may contribute to the higher death rate. Also people have quite different basline levels of fasting IGF-I's, and serotonin must be present enough to even allow GH to be made (a not rarecause of false positive screening IGF-I's). Also there has to be enough arginine to allow growth hormone production. (For example diabetics make more arginase).http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3455225/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632344/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671347/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064303/