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Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?
Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
2017 (Engelska)Ingår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 1, s. 101-105Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated beta-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of beta-blockers. This study examines the effect of pre-admission beta-blockade on post-traumatic depression.

Methods: All adult trauma patients (>= 18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) >= 3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission beta-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission beta-blockers were matched 1: 1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively.

Results: A total of 545 patients met the study criteria. Of these, 15% (n = 80) were prescribed beta-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n = 26) of non beta-blocked patients developed post-traumatic depression, compared to only 18% (n = 14) in the beta-blocked group (p = 0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p = 0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p = 0.94) between cohorts.

Conclusion: beta-blockade appears to act prophylactically and significantly reduces the risk of posttraumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.

Ort, förlag, år, upplaga, sidor
Elsevier, 2017. Vol. 48, nr 1, s. 101-105
Nyckelord [en]
Traumatic brain injury, Beta-blockade, Depression
Nationell ämneskategori
Ortopedi Kirurgi
Identifikatorer
URN: urn:nbn:se:oru:diva-54816DOI: 10.1016/j.injury.2016.10.041ISI: 000390544600018Scopus ID: 2-s2.0-85005893752OAI: oai:DiVA.org:oru-54816DiVA, id: diva2:1066766
Tillgänglig från: 2017-01-19 Skapad: 2017-01-19 Senast uppdaterad: 2019-05-15Bibliografiskt granskad
Ingår i avhandling
1. The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress
Öppna denna publikation i ny flik eller fönster >>The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Traumatic injury and major abdominal surgery are areas in general surgery associated with high rates of morbidity and mortality. The overall colorectal cancer surgery mortality rate is around 4%, with that for emergency surgery more than twice as high as for planned. Surgical morbidity varies between 25% and 45%. Around half of trauma patients develop low mood. In one quarter of patients this becomes permanent. Depression is known to impede physical rehabilitation and recovery. The onset of physiological stress, driven by adrenergic hyperactivity following traumatic and surgical injury is hypothesized to contribute to these adverse outcomes. Interest has therefore been sparked into blocking adrenergic receptor activation.

Papers I and II investigated the role of beta-blocker therapy in preventing post-traumatic depression following severe traumatic brain injury (Paper I) and severe extracranial injury (Paper II). The Karolinska University Hospital Trauma Registry was used to identify patients admitted between 2007 and 2011. In Paper I (n = 545), patients on pre-injury beta-blocker therapy were matched to beta-blocker naïve patients with equivalent injury burden. Results revealed that beta-blocked patients exhibited a 60% reduced risk of needing antidepressant therapy within one year of trauma. In Paper II (n = 596), the lack of beta-blocker use before extracranial trauma was linked to a three-fold increase in the risk of antidepressant initiation.

Papers III-V explored the role of pre-operative beta-blocker therapy in patients undergoing surgery for colorectal cancer between 2007 and 2016, identified using the nationwide Swedish Colorectal Cancer Registry. Paper III (n = 3,187) identified a 69% reduction in the risk of 30-day mortality in beta-blocked patients. Paper IV (n = 22,337) outlined long-term survival benefits for patients on beta-blocker therapy prior to undergoing elective surgery for colon cancer. Beta-blocked patients showed a risk reduction of 42% for 1-year all-cause mortality and 18% for 5-year cancerspecific mortality. Similarly, patients on beta-blocker therapy who underwent surgery for rectal cancer demonstrated improved survival up to one year after surgery with a risk reduction of 57% and a reduction in anastomotic failure and infectious complications in Paper V (n = 11,966).

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2019. s. 96
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 194
Nyckelord
Beta-blocker therapy, adrenergic hyperactivity, physiological stress, trauma, depression, colorectal cancer, complications, mortality
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-73256 (URN)978-91-7529-277-9 (ISBN)
Disputation
2019-06-05, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 10:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-03-21 Skapad: 2019-03-21 Senast uppdaterad: 2019-08-07Bibliografiskt granskad

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Ahl, RebeckaSjölin, GabrielMohseni, Shahin

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