Citation

Tabor J, La PL, Kline GA, Wang M, Bonfield S, Machan M, Wynne-Edwards K, Emery C, Debert CT. J. Neurotrauma 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2022.0190

PMID

35906800

Abstract

Increasing rates of sport-related concussion (SRC) in youth impose a significant burden on public health systems and the lives of young athletes. Accurate prediction for those likely to develop persistent post-concussion symptomology (PPCS) using a fluid biomarker, reflecting both acute injury and recovery processes, would provide the opportunity for early intervention. Cortisol, a stress hormone released through the hypothalamic-pituitary-adrenal (HPA) axis following injury may provide a missing physiological link to clinical recovery. This cohort study investigated the change in saliva cortisol following SRC and the association between cortisol and symptom burden in pediatric ice hockey players. Further, the association between cortisol levels and medical clearance to return to play is explored. In total, cortisol samples from 233 players were included; 165 athletes (23.6% female) provided pre-injury saliva and 68 athletes (19.1% female) provided post-SRC saliva samples for cortisol analysis. Quantile (median) regressions were used to compare cortisol between pre-injury and post-SRC groups, and the association between total symptoms (/22) and symptom severity scores (/132) reported on the SCAT3/SCAT5) and post-SRC cortisol (adjusting for age, sex, history of concussion, and time from injury to sample collection).

RESULTS demonstrated significantly lower saliva cortisol in post-SRC athletes compared to the pre-injury group (β=-0.62, 95% CI [-1.08, -0.16], p=0.009). Post-SRC cortisol was not significantly associated with SCAT3/SCAT5 symptom totals or symptom severity scores, however females were found to report more symptoms (β=6.95, 95% CI [0.35, 13.55], p=0.040) and greater symptom severity (β=23.87, 95% CI [9.58, 38.15], p=0.002) compared to males. Exploratory time-to-event analysis revealed a point estimate suggesting a potential association between low cortisol levels and days to medical clearance to return to play. While preliminary, these findings suggest that the HPA-axis may be dysregulated post-SRC. Furthermore, our exploratory analysis and case presentation of post-injury outliers highlight the need to further research cortisol as a prognostic biomarker to inform individualized sex-specific care after SRC.

Language: en

Keywords

BIOMARKERS; HEAD TRAUMA; HYPOPITUITARISM; PEDIATRIC BRAIN INJURY