Changes in blood glucose after head injury and its prognostic significance

Pentelényi, T; Kammerer, L

doi:10.1016/0020-1383(77)90099-7

Cited by 16 publications

(11 citation statements)

References 13 publications

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“…Hyperglycemia is associated with poorer outcome across the different disease entities treated in intensive care units, including acute myocardial infarction (Capes et al, 2000;Norhammar et al, 1999) and stroke (Capes et al, 2001). Many studies in TBI have also reported a relation between hyperglycemia and poor outcome (Pentelenyi and Kammerer, 1977;Michaud et al, 1991;Margulies et al, 1994;Yang et al, 1995;Lannoo et al, 2000;Paret et al, 1999;Walia and Sutcliffe, 2002;Diaz-Parejo et al, 2003;Glenn et al, 2003;Cochran et al, 2003;Kotsou, 2000, 2004;Zygun et al, 2004).Threshold values of 11.1 mmol/L (Lam et al, 1991;Young et al, 1989;Rovlias and Kotsou, 2004) or higher (Pentelenyi and Kammerer, 1977;Deloof et al, 1979;Merguerian et al, 1981) Odds ratio (OR) is calculated for GOS dichotomized as less than good recovery (D/V/SD/MD vs. GR), unfavorable outcome (D/V/SD vs. MD/GR), death/vegetative versus conscious survival (D/V vs. SD/MD/GR) and death versus survival, as well as with a proportional odds model, with their 95% confidence intervals. Odds ratios refer to the comparison of lab values at the 75th percentile versus the 25th percentile, except for sodium, where comparisons are between categories of low (Ͻ25th percentile) and high (Ͼ75th percentil) values versus a category of middle values (25th to 75th percentile).…”

Section: Glucosementioning

confidence: 95%

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Beek

Mushkudiani²,

Steyerberg³

et al. 2007

Journal of Neurotrauma

206

146

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Abnormalities in laboratory parameters are frequent following traumatic brain injury (TBI), but few studies have investigated their predictive value. We aimed to describe and quantify the relation between laboratory parameters that are routinely determined on admission and final outcome following TBI. Individual patient data were available in the IMPACT database from six Phase III randomized controlled trials and one observational study in TBI. We studied glucose (N = 4834), sodium ( N = 5270), pH ( N = 3398), hemoglobin (Hb, N = 3875), platelet count ( N = 1629), and prothrombin time (PT; N = 840) for their associations with outcome at 6 months (Glasgow Outcome Scale [GOS]). We used logistic regression models with linear, quadratic, and restricted cubic spline functions. The strength of the associations was expressed as an unadjusted odds ratio, calculated over the shift in outcome between the 25th and 75th percentiles. Proportional odds methodology was further applied to quantify the strength of the associations across the full range of the GOS. All parameters were consistently associated with outcome in a continuous relationship: glucose and prothrombin time showed a positive linear relation to outcome (i.e., increasing values associated with poorer outcome) and Hb, platelets, and pH an inverse linear relation (i.e., low values associated with poorer outcome). Sodium demonstrated a U-shaped relation to outcome, with low levels being more strongly related to poorer outcome. Effects were strongest for increasing levels of glucose (odds ratio 1.7; 95% CI 1.54-1.83) and decreasing levels of Hb (odds ratio 0.7; CI 0.60-0.78). Higher glucose values were associated with increasing age, but on adjusted analysis, the strength of the association with outcome remained. Whether treatment of abnormal values may improve outcome needs further rigorous study.

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Section: Glucosementioning

confidence: 95%

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Beek

Mushkudiani²,

Steyerberg³

et al. 2007

Journal of Neurotrauma

206

146

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“…Many studies have reported that hyperglycemia adversely affects clinical outcome in patients with severe traumatic brain lesions and stroke [1,2,3,4,5,6,7]. About 30% of patients with ischemic stroke have diabetes mellitus, which may be responsible for high blood glucose level and for a poorer prognosis [8].…”

Section: Introductionmentioning

confidence: 99%

Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma

Diaz-Parejo

Ståhl

et al. 2003

Intensive Care Med

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Critical Care 2003, 7(Suppl 2):P001 (DOI 10.1186/cc1890) Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogo-nadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypo-pituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. To investigate cortisol reserve in head trauma, 35 consecutive patients (30 men) with a mean age of 36 ± 16 years were studied 5-60 days after physical injury. Patients were enrolled in the study within a few days before ICU discharge. First, a morning blood sample was obtained to measure baseline cortisol, and ACTH plasma levels. Subsequently, 1 µg synthetic ACTH was injected intravenously and, 30 min later, a second blood sample was drawn to determine stimulated plasma cortisol. Patients having stimulated cortisol levels below 18 µg/dl were defined as nonresponders to the low-dose stimulation test (LDST). Mean (± SD) values for ACTH, baseline, and stimulated cortisol concentrations were 49 ± 27 pg/ml, 19.7 ± 5.5 µg/dl and 23.6 ± 6.7 µg/dl, respectively. Six of the 35 patients (17%) failed the LDST. Nonresponders were similar to responders with regard to age, gender, and severity of head injury. However, nonresponders more frequently required vasopressors (6/6 vs 14/29, P = 0.02) and for a longer time interva...

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“…119]. High blood glucose levels following acute brain injury [120,121] and subarachnoid hemorrage [118. 122-124] have been associated with poor neu rological recovery.…”

Section: Predictive Value Of Laboratory Parameters In Serum and Cerebmentioning

confidence: 99%

The Prognostication of Cerebral Hypoxia after Out-of-Hospital Cardiac Arrest in Adults

1997

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Early determination of outcome after out-of-hospital cardiopulmonary resuscitation is a common problem with great ethical, economic, social and legal consequences. Although there has been a fulminant development of emergency medicine during the last three decades, severe cerebral damage sometimes cannot be avoided. For neurological outcome prediction after cardiac arrest clinical neurological signs, electrophysiological examinations, neuroimaging tests, and laboratory parameters in serum and cerebrospinal fluid are used today, nevertheless, there still remains a considerable degree of uncertainty. However, although prognostic criteria which enable the clinician to stop treatment cannot be given at the present time, useful applications of early prognostication after cardiac arrest range from counseling of families, triage decisions, and do-not-resuscitate decisions to future clinical investigations of brain resuscitative measures.

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Changes in blood glucose after head injury and its prognostic significance

Cited by 16 publications

References 13 publications

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma

The Prognostication of Cerebral Hypoxia after Out-of-Hospital Cardiac Arrest in Adults

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