Progesterone as a marker of outcome of severe traumatic brain injury

Background. The article details the role of progesterone (PGN) as a neuroprotective agent in severe traumatic brain injury (STBI) and the feasibility of its use as a biochemical marker for disease prognosis. The purpose: based on the analysis of PGN changes in the blood plasma of victims, to prove the feasibility of using it as a biochemical marker for predicting the severity and outcomes of STBI. Materials and methods. A total of 280 male patients with STBI were examined who received standardized treatment taking into account modern evidence-based recommendations. They were divided into groups of young (n = 165) and mature (n = 115) age. According to the initial severity, victims were divided into three groups: group I (severe condition) included 73 patients; group II (extremely severe condition) — 180 people; group III (terminal condition) consisted of 27 victims. Based on the degree of structural damage to the brain and cerebrospinal fluid spaces, the patients were also divided into four clinical groups: group A (n = 51) — severe cerebral contusion; group B (n = 112) — severe cerebral contusion combined with subarachnoid hemorrhage (SAH); group C (n = 83) — severe cerebral contusion combined with hematomas of various location; group D (n = 34) — severe cerebral contusion combined with SAH and intracranial hematomas. Each group was divided into survivors and those who died during the treatment stages. Examinations were conducted on days 1, 3, 5, 7, 10, and 14 after the injury. Mathematical processing of the obtained data was carried out using methods of variational statistics. Results. The average mortality among the examined was 48.9 %. In survivors, the PGN level significantly exceeded the norm by 2,737.6 % on day 1 after the injury. In case of an unfavorable outcome of STBI, the hormone level exceeded the norm to a significantly lesser extent. In young survivors, the PGN level significantly exceeded the norm by 2,779.4 %, in mature ones — by 2,513.2 %. In those who died later, the rise in PGN in both age categories was significantly lower. Among survivors admitted in severe or extremely severe condition, the PGN level was the highest on the day 1 of observation. In victims who were admitted in extremely severe or terminal condition and died later, an increase in PGN was smaller. Analysis of PGN changes across clinical groups showed significant and independent increase in its level at all stages of observation, regardless of the degree of structural brain damage. However, the degree of a rise decreased in proportion to the severity of structural abnormalities. Conclusions. In males, STBI is accompanied by a significant increase in serum PGN independently of outcome. Among survivors, the degree of PGN rise is significantly higher and does not depend on age or severity upon admission, which allows us to attribute PGN to markers for predicting the severity and outcome of STBI.