Relationship between plasma cortisol levels and stress ulcer following acute and severe head injury.

OBJECTIVE This study was designed to investigate the relationship between plasma cortisol levels and stress ulcer following acute severe head injury. PATIENTS AND METHODS The plasma cortisol levels were prospectively measured by radioimmunoassay in 68 patients following acute head injury. The diagnosis of stress ulcer was based on clinical evidence and was confirmed by endoscopic examination. RESULTS Patients with stress ulcer and gastrointestinal bleeding (n = 30, 44.1%) were older than those without stress ulcer(38.2 +/- 7.9 vs. 28.3 +/- 9.7 years, p < 0.01). The combined rate of poor recovery and death in the stress ulcer patients (70.0%) was significantly higher than in the nonulcer patients (42.1%, p = 0.02). On each of the first 3 days following the head injury, the average plasma cortisol levels in the stress ulcer patients were higher than in the nonulcer patients (p < 0.01). Univariate analysis showed a positive relationship between plasma cortisol on admission and stress ulcer (r = 0.329, p = 0.01). Logistic regression analysis revealed that plasma cortisol levels on admission (OR = 2.326, 95% CI = 1.982-2.466) and age (OR = 1.064, 95% CI = 0.861-1.219) were independent predictors of stress ulcer. CONCLUSIONS The data showed that acute severe head injury was associated with a significant increase in plasma cortisol. Plasma levels of cortisol and age were independent predictors of stress ulcer following acute head injury.