Assessing the correlation of trauma severity, blood sugar level, and neurologic outcomes in traumatic spinal cord injury patients

Abstract

Trauma, due to stimulating stress responses like hormones, increases the blood sugar level (BS level). 1 by inducing neurohormonal reactions, acute trauma leads to changes in carbohydrate, protein, and fat metabolism. As it was said, by releasing special cytokines and body defense regulating hormones, trauma results in increased BS level (hyperglycemia), which significantly affects body function and treatment process. In fact, hyperglycemia is a compensatory response of the body against trauma and stress. We are aware of multifactorial etiology of hyperglycemia in trauma patients. Though it seems that activation of the sympathoadrenal system (by hypothalamus and pituitary) is the major factor of increased BS level. ac.ir/JARCMTrauma, due to stimulating stress responses like hormones, leads to increased blood sugar level (BS level), which worsens cerebrospinal and renal damages. Admission hyperglycemia associated with poor outcomes in severe traumatic injuries, therefore glucose control leads to improved outcomes and better prognosis of these patients. This study aims to analyze the impact of severity of spinal cord injury (SCI) (based on Frankel classification) on BS level in these patients. Furthermore, the effect of controlling the BS level in a normal range on improving the neurological outcomes [muscular force (MF)] was examined. This is a cross-sectional study in which admission BS level of all SCI patient, were measured, and regular treatments were applied based on standard protocols. The recovery process of motor and sensory disorders was also examined in discharge and was evaluated with the primarily measured BS level. Besides, patients with high BS level (more than 200 mg/dl) underwent the insulin protocol, and the effects of glucose level control on the final outcome of SCI patients were evaluated.Among the 380 patients enrolled in this study, 266 were male (70%) and 114 were female (30%). The mean age of patients was 35.84 ± 18-65 years old. The mean hospital length of stay was 5.98 days (from 3 to 14 days). The mean BS level in patients with MF of 0/5, 1/5, 2/5, 3/5, 4/5 and 5/5 were 169.8, 185.9, 177.3, 172.8, 117.5 and 118.0 mg/dl, respectively. The rate of MF changes was measured in hyperglycemic patients who underwent an insulin protocol.As the SCI trauma becomes more severe, the BS level increases with a higher rate. Besides, there was a significant difference (P = 0.001) in MF of patients before and after the insulin protocol prescription.

Predictive Value of Vital Signs at Presentation in Individuals with Severe Traumatic Brain Injuries

“…Liu-DeRyke et al (30) shown that the strongest predictive value for predicting outcome is peak random blood sugar within the first twenty-four hours following injury and admission. In patients who have experienced a TBI, a high blood glucose level is a predictor of early mortality and a worse result (31,32) .…”

Admission hyperglycaemia as a prognostic indicator of outcome in major trauma patients at Bugando Medical Centre, Mwanza, Tanzania

“…Among trauma patients, the association of outcome with hyperglycemia has been studied extensively in major trauma patients, in whom it portends a poorer prognosis (Gore et al, 2002;Yendamuri et al, 2003;Simsek et al, 2014;Torbati et al, 2015). This finding is attributed to the fact that trauma patients present with a hypermetabolic response to injury that is driven by an increase in the activity of the hypothalamus and sympathetic nervous system that leads to an increased release of ACTH, catecholamine, and glucagon.…”

“…Even though stress-induced hyperglycemia has been associated with an increase in morbidity and mortality among patients with major trauma (Simsek et al, 2014;Torbati et al, 2015), the available literature on stress-induced hyperglycemia post-trauma has been conducted in the developed world (Gore et al, 2002;Yendamuri et al, 2003;Sung et al, 2011;Simsek et al, 2014;Torbati et al, 2015). This study is distinct from other reports in the literature, for its setting in a developing country with unique characteristics, challenges, and the largest burden of trauma.…”

“…Previously, this hyperglycemia was perceived as a 'normal' response to major trauma; thus, the intervention was thought unnecessary (Black et al, 1990). However, recent studies have established an association between hyperglycemia and poor outcome in patients with major trauma (Gore et al, 2002;Yendamuri et al, 2003;Simsek et al, 2014;Torbati et al, 2015). Early recognition and treatment of this profound metabolic change have been shown to improve clinical outcomes (Torbati et al, 2015).…”

Effects on Outcomes of Hyperglycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury

“…Fourth, the severity and level of SCI are wellrecognized prognostic factors for recovery after traumatic SCI and, hence, both factors should be considered in the data analyses as potential confounders. 36 Further, Torbati and associates 37 reported that at an acute care spine trauma in Iran individuals with more severe SCI had higher glycemic levels on admission.…”