Clinical Impact of Early Hyperglycemia During Acute Phase of Traumatic Brain Injury

Abstract

Findings from our study suggest a glucose level > or =160 mg/dl within the first 24 h of admission following TBI is associated with poor outcomes irrespective of severity of injury, and this presents a timeframe for which active therapeutic interventions may improve clinical outcomes. Prospective efficacy trials are needed to corroborate these findings.

Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

“…Association between baseline variables and both the presence of CE and the outcomes were examined. Thresholds for age Ͼ65 years, 31 glucose level Ͼ8.3 mm/L, 14,32 Glasgow Coma Scale score Յ8, 9,33 and midline shift Ն5 mm [34][35][36] were selected on the basis of previous data and clinical relevance. Continuous data were assessed by using the Student t test or Wilcoxon rank-sum test, on the basis of normality of data by using the Shapiro-Wilk test.…”

“…32 Initial hematoma volume 2,3,6,9,42,43 and midline shift 35,36,[42][43][44] are potent predictors of intracranial hematoma progression and poor outcome but have also been shown to be collinear. 42,45 Contrast extravasation could, therefore, potentially offer additional information not provided by NCCT, though this would need to be assessed by directly comparing NCCT with CTA/PCCT.…”

Disorders of carbohydrate metabolism in experimental brain injury

“…Increased level of glucose after trauma was marked by other writers [14,15]. This fact was explained by catabolic hormones (catecholamines, glucocorticoids) rising and glycogenolysis and gluconeogenesis activation, first of all in the liver.…”

“…Oxygen necessity of brain increase, but disorders of circulation, accumulation of lactate, formation of acidosis lead to hypoxia [13]. Activation of glycolysis and gluconeogenesis, formation of tissue tolerance to insulin, hyperglycemia are observed [14,15]. Level of hyperglycemia correlate with severity of injury [16].…”

Traumatic Brain Injury - Acute Care

“…Close monitoring is essential to ensure adequate supplementation and avoid complications such as hyperglycemia. Early hyperglycemia has been associated with poor outcome in TBI patients (Liu-DeRyke et al 2009), but intensive glycemic control may exacerbate metabolic stress in some patients (Vespa et al 2006). Although the optimal glucose range for TBI patients has yet to be determined, our institution has chosen 140-180 mg/dL as a reasonable target range.…”