Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

Abstract

Background Traumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda. Objective We aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda. Methods We consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without. Results Most patients (92.9%) were male aged 18–30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554]; P = 0.009) were significant predictors of mortality. Conclusion Hypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings.

Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

“…Unlike other brain pathologies, such as ischemic stroke and intracerebral hemorrhage, the target blood glucose range for TBI has not been well documented. Although 6.0–10.0 mmol/L was predicted as the appropriate target range of blood glucose [ 1 , 22 ], this range has not been fully substantiated by clinical research. In a previous stud y[ 15 ], based on the effect of IIT on 3- and 6-month survival and GOS, we found that the medium-control IIT group exhibited the best GOS compared to the tight-control IIT group and slight-control IIT group, while mean glucose levels in the medium-control group fell in the range of 7.1 to 13.0 mmol/L.…”

“…Traumatic brain injury (TBI) leads to death and disability in patients. Secondary brain injury significantly affects the prognosis of patients with TBI, while hyperglycemia is one of the important factors inducing secondary brain injury [ 1 ]. Recent studies have confirmed that hyperglycemia aggravates nerve damage [ 2 ].…”

Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study

“…Secondary injury is a complex process that occurs in the hours and days after primary injury, which encompasses cranial and systemic complications. Matovu et al [ 72 ] showed that 1 in 6 patients with severe TBI admitted to a hospital in Uganda had blood glucose levels higher than 11.1 mmol/L. Patients with hyperglycemia were 1.47 times more likely to die within 30 days compared to those with no hyperglycemia, but this association was not statistically significant (OR: 1.47; 95% CI [0.236–9.153], p = 0.680).…”

Association between blood glucose levels in insulin therapy and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

“…Unlike other brain diseases, such as ischemic stroke and intracerebral hemorrhage, the target blood glucose range for TBI has not been well documented. Although 6.0-10.0 mmol/L was predicted as the appropriate target range of blood glucose [1,22], this range was not fully substantiated by clinical research. In a previous study, based on the effect of IIT on 3and 6-month survival and GOS, we introduced that the blood glucose between 7.1 and 13.0 mmol/L would be the suitable target range for controlling hyperglycemia with insulin therapy following TBI.…”

“…Traumatic brain injury (TBI) leads to death and disability in patients with trauma. Secondary brain injury affects the prognosis of patients with TBI signi cantly, while hyperglycemia is one of the important factors inducing secondary brain injury [1]. Recent studies con rmed that hyperglycemia could aggravate the damage of nerve function [2].…”