Acute Diabetes Insipidus in Severe Head Injury: A Prospective Study
Abstract
BACKGROUND: The incidence and risk factors for acute diabetes insipidus after severe head injury and the effect of this complication on outcomes have not been evaluated in any large prospective studies. STUDY DESIGN: We conducted a prospective study of all patients admitted to the surgical ICU of a Level I trauma center with severe head injury (head Abbreviated Injury Score [AIS] >or= 3). The following potential risk factors with p < 0.2 on bivariate analysis were included in a stepwise logistic regression to identify independent risk factors for diabetes insipidus and its association with mortality: age, mechanism of injury (blunt or penetrating), blood pressure, Glasgow Coma Scale, Injury Severity Score, head and other body area AIS, skull fracture, cerebral edema and shift, intracranial hemorrhage, and pneumocephaly. RESULTS: There were 436 patients (blunt injuries, 392; penetrating injuries, 44); 387 patients had isolated head injury. Diabetes insipidus occurred in 15.4% of all patients (blunt, 12.5%; penetrating, 40.9%; p < 0.0001) and in 14.7% of patients with isolated head injury (blunt, 11.8%; penetrating, 39.5%; p < 0.0001). The presence of major extracranial injuries did not influence the incidence of diabetes insipidus. Independent risk factors for diabetes insipidus in isolated head injury were Glasgow Coma Scale 3. Diabetes insipidus was an independent risk factor for death (adjusted odds ratio, 3.96; 95% CI [1.65, 9.72]; adjusted p value = 0.002). CONCLUSIONS: The incidence of acute diabetes insipidus in severe head injury is high, especially in penetrating injuries. Independent risk factors for diabetes insipidus include a Glasgow Coma Scale 3. Acute diabetes insipidus was associated with significantly increased mortality.
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Central DI/AVP-D is associated with mortality after TBI.
“a number of studies have reported that central DI/AVP-D is associated with mortality [3, 9, 12, 13].”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [12]
Central DI/AVP-D has been described in 14-26% of patients in the acute period after TBI.
“Central DI, or arginine vasopressin deficiency (AVP-D), has been described in 14-26% of patients in the acute period after TBI [12-14].”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [12]
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- Authors
- Hadjizacharia, P., Beale, E. O., Inaba, K., Chan, L. S., & Demetriades, D.
- Affiliations
- University of Southern California (US)
- Corresponding author
- Beale, Elizabeth O.
- Venue
- Journal of the American College of Surgeons
- Published
- 2008-10
- Volume
- 207
- Issue
- 4
- Pages
- 477-484
- ISSN
- 1072-7515 (ISSN-L)
- OpenAlex
- W2061509967
- Semantic Scholar
- 05ce77a5fa1d6f395c628ea28b58b42cb31a1d20
- Cited by
- 90
- References
- 22
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 2 · 2020: 10 · 2019: 5 · 2018: 9 · 2017: 5 · 2016: 6 · 2015: 8 · 2014: 1 · 2013: 5 · 2012: 5
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- severe traumatic brain injury, penetrating head injury, blunt head trauma, risk factors, mortality, Glasgow Coma Scale, traumatic brain injury complications, neurocritical care
- MeSH terms
- Adolescent, Adult, Diabetes Insipidus, Female, Craniocerebral Trauma, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Incidence
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