Admission Hyperglycemia Is Predictive of Outcome in Critically Ill Trauma Patients

Sung, Jin Yong; Bochicchio, Grant V.; Joshi, Manjari; Bochicchio, Kelly; Tracy, Kate; Scalea, Thomas M.

doi:10.1097/01.ta.0000171452.96585.84

Cited by 309 publications

(272 citation statements)

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“…The explanation would be that these patients have a more important metabolic response to injury due to the effects of cortisol, glucagon and epinephrine release, causing intrac-pediatric head trauma: hyperglycemia Melo et al ellular acidosis, lactate accumulation, high blood glucose levels and neuronal injury 6,[19][20][21] . Therefore, our data are in accordance with the results from other authors who correlate the head trauma severity and the metabolic response to trauma, particularly higher blood glucose levels 7,22,23 . Some studies show that hyperglycemia is associated with a worse outcome, regardless of injury characteristics 24 .…”

Section: Discussionsupporting

confidence: 83%

“…However, high blood glucose is common in acutely ill neurological patients, even in non-diabetics ones. A consensus regarding the cut-off blood glucose level that would be related to a poor prognosis in children and adolescents with head trauma is still lacking, which makes the comparison of different studies particularly troublesome [3][4][5][6][7][8][9] .…”

mentioning

confidence: 99%

“…Some authors believe that patients with hyperglycemia generally have a low Glasgow Coma Scale (GCS) score [3][4][5][6] , poor neurological prognosis (based on GCS) and a history of severe trauma with significant brain injury 6,7 . It is well known that such acute hyperglycemia is a result of catecholamine' effects 8,9 .…”

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confidence: 99%

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Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). Method: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. Results: A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. Conclusion: Hyperglycemia was more prevalent in patients with severe head trauma (GCS ≤8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.Key WordS: adolescents, children, head trauma, hyperglycemia, prevalence. Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversalResumo -Objetivo: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS). Método: estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. Resultados: 340 crianças foram incluídas no estudo e 60 (17,6%) apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9% dos casos de trauma craniano leve, 30,4% daqueles com trauma craniano moderado e em 49% dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85% apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. Conclusão: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS ≤8), assim como naqueles com alterações identificadas na tomografia computadorizada do crânio, independente da presença de politraumatismo.

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Section: Discussionsupporting

confidence: 83%

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confidence: 99%

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Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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“…1,[6][7][8]20,21 The association of hyperglycemia with increased mortality has been demonstrated in several populations of critically ill human patients, suffering from both medical and surgical conditions and comprising different age groups. [1][2][3][4][5][6][7][8][9] Blood glucose concentrations at admission have been revealed to be associated with survival to hospital discharge in horses with colic, with higher blood glucose concentrations being associated with a less favorable prognosis. 11,12 The degree of hyperglycemia in human patients is associated with the severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

Blood Glucose in Horses with Acute Abdominal Disease

Hollis¹,

Boston²,

Corley

2007

J Vet Int Med

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Background: Hyperglycemia in critically ill humans is associated with increased glucose production and insulin resistance and is associated with death. This might also be true in horses presenting with acute abdominal disease.Hypothesis: Throughout hospitalization, hyperglycemia will be common in adult horses presenting with acute abdominal disease. Hyperglycemia will be associated with a worse prognosis for survival to hospital discharge.Animals: Two hundred sixty-nine adult horses with acute abdominal disease. Methods: Observational retrospective study. Records were reviewed for 269 horses that had glucose data analysed and recorded at the time of hospital admission: 154 horses had a first sample after admission; 110 horses at 24 hours after admission; 74 horses at 36 hours after admission; and 49 horses at 48 hours after admission. Logistic regression analyses were performed to investigate the association of glucose concentrations with survival, in addition to the association of glucose concentrations with surgical, small intestinal, strangulating lesions, and lesions requiring a resection.Results: Of 269 horses presenting with acute abdominal disease, 50.2% had blood glucose concentrations greater than the reference range (75.6-131.4 mg/dL); 0.4%, below the reference range; and 49.4%, within the reference range at admission. Of 269 horses, 2.3% had blood glucose concentrations below the reference range at some point during the first 48 hours of hospitalization, all of which had strangulating intestinal lesions. Horses that did not survive to hospital discharge had a higher mean blood glucose concentration at admission; at the first sample after admission; at 24, 36, and 48 hours after admission; and higher maximum and minimum blood glucose concentrations in the first 24 hours after admission.Conclusions and Clinical Importance: Derangements of blood glucose concentration are common in horses with acute abdominal disease. Hyperglycemia is much more common than hypoglycemia in these animals. Hyperglycemia in the first 48 hours of hospitalization is associated with a worse prognosis for survival to hospital discharge.

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“…4 It has been associated with adverse clinical outcomes, including increased mortality, increased duration of mechanical ventilation, increased intensive care unit (ICU) and hospital stay, and increased risk of infection. [5][6][7][8] Hyperglycemia in critical illness is managed with exogenous insulin as standard treatment; however, there is considerable disagreement among experts in the field as to what target blood glucose level is optimal for the critically ill patient. Conventionally, the aim of insulin therapy has been to maintain blood glucose levels below the renal threshold, typically 220 mg/dL (12.2 mmol/L).…”

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confidence: 99%