Evaluation of BDNF levels in patients hospitalized for physical trauma at an emergency hospital in Porto Alegre, southern Brazil

Zatti, Cleonice; Guimarães, Luciano Santos Pinto; Santana, Márcia Rosane Moreira; Scherner, Eliana Ferreira Gonçalves; Salle, Emílio; Piltcher, Renato; Spader, Mariana Lunardi; Calegaro, Vitor Crestani; Wollenhaupt-Aguiar, Bianca; Freitas, Lúcia Helena Machado

doi:10.1590/2237-6089-2018-0060

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Original Articles • Trends Psychiatry Psychother. 41 (3) • Jul-Sep 2019 • https://doi.org/10.1590/2237-6089-2018-0060 copy

Evaluation of BDNF levels in patients hospitalized for physical trauma at an emergency hospital in Porto Alegre, southern Brazil

Avaliação dos níveis de BDNF em pacientes hospitalizados por trauma físico em um hospital de emergência de Porto Alegre, sul do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma.

Methods

Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years.

Results

We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (U_morning = 1107, p_morning = 0.575; U_afternoon = 7175, p_afternoon = 0.028).

Conclusions

The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.

Acute stress disorder; BDNF; physical trauma; trauma in childhood

Percent	Morning (n = 38)	Afternoon (n = 79)
Min	0.3	1.4
10	3.4	5.4
20	5.2	10.9
30	9.2	19.6
40	14.4	25.5
50	20.2	28.6
60	23.2	33.1
70	26.1	41.2
80	35.5	56.1
90	56.5	69.6
Max	89.2	132.2

	Morning				Afternoon

	Median [Q1; Q3]	Min-Max	n	p	Median [Q1; Q3]	Min-Max	n	p
Sex
Male	20.6 [8.4; 28.8]	3.2-89.2	33	0.714	28.5 [13.5; 42.5]	1.8-132.2	70	0.507
Female	19.5 [18.3; 24.4]	0.3-26.5	5		38.3 [19.7; 49.9]	1.4-117.8	9

Psychiatric history
Yes	28.2 [14.9; 39.0]	14.9-39.0	3	0.291	27.0 [12.2; 38.2]	1.4-77.2	17	0.352
No	19.8 [6.5; 26.5]	0.3-89.2	35		30.7 [14.0; 46.4]	1.8-132.2	62

Age range (years)
18-30	16.6 [10.0; 27.3]	6.5-54.6	12	0.575	20.1 ^a [8.5; 33.1]	1.4-117.8	33	0.028
31-50	23.3 [13.8; 27.3]	3.2-73.7	16		30.2 ^ab [19.7; 46.4]	1.9-132.2	33
51-70	10.1 [3.5; 34.6]	0.3-89.2	10		38.6 ^b [31.2; 52.5]	17.2-85.1	12

Admission reason
Aggression	10.9 [6.5; 19.8]	0.3-28.8	9	0.135	25.6 [17.5; 41.7]	1.4-132.2	32	0.712
Accident	23.1 [8.8; 31.4]	3.2-89.2	24		30.7 [11.5; 50.9]	1.8-117.8	36

	Morning				Afternoon

	Mean [Q1; Q3]	Min-Max	n	p	Mean [Q1; Q3]	Min-Max	n	p
ASD A1
Yes	21.3 [8.4; 26.5]	0.3-89.2	30	0.830	27.0 [10.9; 38.8]	1.4-117.8	55	0.013
No	16.6 [7.4; 46.8]	3.4-86.0	8		39.6 [23.8; 67.0]	3.1-132.2	24

ASD A2
Yes	20.0 [5.3; 24.5]	0.3-89.2	22	0.408	22.8 [8.5; 38.2]	1.4-132.2	37	0.025
No	21.2 [9.2; 33.9]	3.4-86.0	16		31.7 [21.6; 56.2]	3.1-79.4	42

ASD A3
Yes	20.0 [5.8; 27.6]	0.3-89.2	20	0.640	25.7 [9.1; 41.2]	1.8-85.1	35	0.236
No	21.0 [9.2; 28.2]	3.4-86.0	18		31.5 [18.7; 46.1]	1.4-132.2	44

ASD A4
Yes	22.0 [9.2; 28.2]	0.3-89.2	15	0.800	28.9 [8.9; 45.7]	1.9-85.1	19	0.783
No	19.5 [6.5; 28.8]	3.2-86.0	23		28.5 [13.7; 45.0]	1.4-132.2	60

ASD A
Yes	19.8 [8.4; 25.9]	0.3-89.2	33	0.235	27.2 [13.0; 41.8]	1.4-132.2	66	0.044
No	39.0 [10.9; 54.6]	3.8-86.0	5		41.0 [27.1; 66.5]	3.1-79.4	13

ASD B
Yes	21.7 [8.7; 25.4]	0.3-34.6	8	0.802	19.9 [8.5; 41.2]	1.4-51.9	10	0.288
No	20.2 [8.4; 28.8]	3.2-89.2	30		28.9 [17.7; 46.4]	1.8-132.2	69

ASD C
Yes	20.2 [8.4; 28.2]	0.3-89.2	38	-	28.6 [13.5; 45.7]	1.4-132.2	79	-
No			0				0

ASD D
Yes	24.2 [8.7; 30.5]	0.3-89.2	16	0.460	27.5 [13.5; 49.9]	4.1-132.2	27	0.975
No	19.1 [8.4; 28.2]	3.2-86.0	22		29.6 [13.5; 43.0]	1.4-117.8	52

ASD E
Yes	25.4 [19.5; 28.8]	5.3-89.2	10	0.079	26.6 [9.1; 41.0]	1.8-77.2	18	0.520
No	16.6 [5.8; 25.2]	0.3-86.0	28		30.2 [14.0; 46.4]	1.4-132.2	61

ASD
Positive	24.0 [19.5; 24.4]	3.4-26.5	5	0.983	23.6 [5.9; 41.2]	5.9-41.2	2	0.640
Negative	19.8 [8.4; 28.8]	0.3-89.2	33		28.6 [14.0; 45.7]	1.4-132.2	77

	Morning				Afternoon

	Mean [Q1; Q3]	Min-Max	n	p	Mean [Q1; Q3]	Min-Max	n	p
Current depression
No	21.3 [9.3; 34.6]	3.2-89.2	26	0.370	28.8 [17.2; 46.4]	1.4-132.2	58	0.807
Yes	14.9 [5.3; 24.5]	0.3-51.1	11		28.4 [13.0; 41.2]	4.1-73.6	21

Current melancholy
No	20.6 [9.3; 28.8]	3.2-89.2	29	0.461	27.3 [13.0; 43.0]	1.4-132.2	64	0.194
Yes	16.8 [5.8; 24.2]	0.3-51.1	8		38.0 [25.5; 51.9]	5.9-73.6	15

Past depression
No	19.8 [8.4; 28.2]	3.2-89.2	31	0.564	28.6 [17.2; 46.4]	1.4-132.2	63	0.634
Yes	25.2 [6.5; 51.1]	0.3-73.7	6		28.4 [8.9; 45.7]	4.1-69.3	15

Suicide risk
No	22.0 [9.2; 28.2]	0.3-89.2	19	0.902	26.7 [14.0; 41.8]	1.9-117.8	46	0.256
Yes	18.3 [9.3; 24.4]	3.5-86.0	9		33.1 [21.9; 51.9]	1.4-132.2	21

Lifetime psychosis
No	19.8 [6.5; 25.9]	3.2-86.0	27	0.584	31.2 [19.6; 49.9]	1.8-132.2	62	0.061
Yes	22.0 [13.7; 28.8]	0.3-51.1	10		21.9 [8.5; 31.4]	1.4-73.2	17

Primary agoraphobia
No	20.6 [5.3; 28.2]	0.3-89.2	29	0.356	28.8 [17.2; 45.7]	1.4-132.2	66	0.533
Yes	21.9 [14.3; 32.7]	9.3-73.7	8		24.3 [11.5; 39.6]	5.9-73.6	12

Social anxiety disorder
No	20.6 [9.2; 28.8]	3.2-89.2	29	0.400	29.6 [14.0; 46.4]	1.4-132.2	66	0.539
Yes	18.3 [6.5; 24.4]	0.3-34.6	9		23.5 [13.0; 41.2]	5.9-69.6	10

Current alcoholism
No	20.2 [9.2; 28.2]	0.3-89.2	30	0.832	31.1 [17.2; 43.5]	1.8-132.2	53	0.900
Yes	19.5 [6.5; 24.5]	3.8-34.6	6		27.2 [13.0; 51.9]	1.4-77.2	26

Alcohol abuse
No	20.2 [8.4; 28.2]	0.3-89.2	34	0.738	29.4 [13.7; 46.1]	1.4-132.2	60	0.905
Yes	14.9 [6.5; 24.5]	6.5-24.5	3		27.5 [13.0; 41.8]	5.9-77.2	15

Substance dependency
No	19.5 [5.3; 28.2]	0.3-89.2	31	0.801	28.6 [13.0; 45.7]	1.4-132.2	55	0.900
Yes	20.6 [9.2; 22.7]	6.5-24.0	5		27.0 [13.5; 51.9]	1.8-73.2	23

Substance abuse
No	19.7 [5.3; 28.2]	0.3-89.2	30	0.966	31.1 [19.7; 51.9]	1.4-117.8	63	0.021
Yes	15.7 [9.3; 25.9]	8.4-39.0	6		11.3 [8.4; 32.3]	1.9-45.7	12

Current psychosis
No	20.6 [8.4; 28.8]	3.2-89.2	31	0.638	30.7 [15.8; 48.2]	1.8-132.2	64	0.151
Yes	18.3 [3.8; 26.5]	0.3-34.6	7		25.7 [8.2; 33.1]	1.4-73.2	15

Current mental disorder
No	3.4 [3.2; 86.0]	3.2-86.0	3	0.401	38.3 [28.6; 43.5]	5.4-79.4	5	0.469
Yes	20.6 [9.2; 28.2]	0.3-89.2	35		27.9 [13.5; 45.7]	1.4-132.2	74

	Morning	Afternoon
	r (p)	r (p)
Age	-0.11 (0.514)	0.34 (0.003)

ASD A
Number of symptoms	-0.10 (0.568)	-0.28 (0.011)

Defensive Style Questionnaire
Mature	0.15 (0.382)	0.19 (0.105)
Anticipation	0.09 (0.603)	0.11 (0.325)
Humor	0.22 (0.190)	0.01 (0.927)
Suppression	0.18 (0.266)	0.07 (0.533)
Sublimation	-0.05 (0.758)	0.17 (0.143)
Rationalization	0.00 (0.980)	0.22 (0.050)

Neurotic	0.14 (0.405)	0.18 (0.118)
Pseudo-altruism	0.12 (0.466)	0.03 (0.820)
Idealization	0.16 (0.336)	0.01 (0.926)
Reaction formation	0.16 (0.334)	0.27 (0.015)
Undoing	-0.06 (0.737)	0.15 (0.199)

Immature	-0.11 (0.521)	-0.02 (0.887)
Projection	-0.03 (0.848)	-0.06 (0.585)
Passive aggression	-0.21 (0.216)	-0.03 (0.772)
Acting out	-0.29 (0.082)	-0.11 (0.335)
Isolation	0.12 (0.472)	-0.14 (0.214)
Devaluation	-0.27 (0.107)	0.02 (0.847)
Autistic fantasy	-0.16 (0.343)	0.19 (0.102)
Denial	0.11 (0.528)	-0.06 (0.618)
Displacement	-0.07 (0.683)	-0.05 (0.690)
Dissociation	0.05 (0.744)	0.00 (0.975)
Splitting	-0.05 (0.766)	-0.02 (0.837)
Somatization	-0.02 (0.922)	0.03 (0.779)

Childhood Trauma Questionnaire
Emotional abuse score	0.05 (0.794)	-0.15 (0.190)
Physical abuse score	0.23 (0.200)	-0.02 (0.884)
Sexual abuse score	-0.02 (0.926)	-0.15 (0.181)
Emotional neglect score	-0.12 (0.516)	0.09 (0.445)
Physical neglect score	0.21 (0.225)	-0.13 (0.271)
Total score CTQ	0.16 (0.381)	-0.15 (0.202)

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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[1] Correspondence: Cleonice Zatti. Rua Ramiro Barcelos, 2400, 2° andar, Bairro Santana. 90035-003 - Porto Alegre, RS - Brazil. E-mail: cleonice.zatti@outlook.com