{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:31:27Z","timestamp":1785767487266,"version":"3.56.0"},"reference-count":65,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T00:00:00Z","timestamp":1548979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>\n                    Early declines in gonadotropin production, despite elevated serum estradiol, among some individuals with severe traumatic brain injury (TBI) suggests amplified systemic aromatization occurs post-injury. Our previous work identifies estradiol (E2) as a potent mortality marker. Androstenedione (A), a metabolic precursor to E2, estrone (E1), and testosterone (T), is a steroid hormone substrate for aromatization that has not been explored previously as a biomarker in TBI. Here, we evaluated serum A, E1, T, and E2 values for 82 subjects with severe TBI. Daily hormone values were calculated, and E2:A and E1:T ratios were generated and then averaged for days 0\u20133 post-injury. After data inspection, mean E2:A values were categorized as above (high aromatization) and below (low aromatization) the 50th percentile for 30-day mortality assessment using Kaplan-Meier survival analysis and a multivariable Cox proportional hazard model adjusting for age, and Glasgow Coma Scale (GCS) to predict 30-day mortality status. Daily serum T, E1, and E2 were graphed by E2:A category. Serum E1 and E2 significantly differed over time (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05); the high aromatization group had elevated levels and a significantly lower probability of survival within the first 30 days (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.0274). Multivariable Cox regression showed a significant E2:A*GCS interaction (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.0129), wherein GCS predicted mortality only among those in the low aromatization group. E2:A may be a useful mortality biomarker representing enhanced aromatization after TBI. E2:A ratios may represent non-neurological organ dysfunction after TBI and may be useful in defining injury subgroups in which GCS has variable capacity to serve as an accurate early prognostic marker.\n                  <\/jats:p>","DOI":"10.1089\/neu.2018.5677","type":"journal-article","created":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T07:40:26Z","timestamp":1531813226000},"page":"538-547","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Estradiol to Androstenedione Ratios Moderate the Relationship between Neurological Injury Severity and Mortality Risk after Severe Traumatic Brain Injury"],"prefix":"10.1177","volume":"36","author":[{"given":"Prerna","family":"Ranganathan","sequence":"first","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj G.","family":"Kumar","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Mo","family":"Oh","sequence":"additional","affiliation":[{"name":"Seoul National University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milap V.","family":"Rakholia","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Berga","sequence":"additional","affiliation":[{"name":"University of Utah Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy K.","family":"Wagner","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"},{"name":"University of Pittsburgh"},{"name":"University of Pittsburgh"},{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,2]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"Traumatic Brain Injury in the United States: Emergency Department Visits Hospitalizations and Deaths 2002\u20132006 (Blue Book) | Concussion | Traumatic Brain Injury | CDC Injury Center. 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