Mortality Rate Associated with Admission Hyperglycemia in Traumatic Femoral Fracture Patients Is Greater Than Non-Diabetic Normoglycemic Patients but Not Diabetic Normoglycemic Patients

Abstract

Background: Admission hyperglycemia is associated with increased morbidity and mortality in trauma patients. However, admission hyperglycemia is not only associated with stress-induced hyperglycemia (SIH) but also with diabetic hyperglycemia (DH); furthermore, patients with normoglycemia may not only have non-diabetic normoglycemia (NDN) but also have a possibility of diabetic normoglycemia (DN), with the diabetes under control. This study aimed to assess the effects of SIH and DH on the mortality outcomes of traumatic femoral fracture patients with NDN and DN. Methods: Admission hyperglycemia was diagnosed as a serum glucose ≥200 mg/dL upon arrival at the emergency department. Diabetes mellitus (DM) was determined by patient history and/or admission HbA1c ≥ 6.5%. DH and SIH were diagnosed by admission hyperglycemia in patients with and without DM. DN and NDN were determined by absence of admission hyperglycemia in patients with and without DM. These patients were allocated into four groups: SIH (n = 75), DH (n = 280), DN (n = 309), and NDN (n = 1326), with detailed information retracted from the Trauma Registry System at a level I trauma center between 1 January 2009, and 31 December 2016. Patients with incomplete registered data were excluded. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for mortality were estimated through a stepwise model selection of a multiple regression model that was adjusted by controlling the cofounding variables such age, sex, co-morbidities, and Injury Severity Score. Results: Compared to NDN, a 9.8-fold (95% CI 1.54–62.05; p = 0.016) and a 5.8-fold (95% CI 1.46–22.67; p = 0.012) increase in the adjusted mortality odds ratio of patients with SIH and DH, respectively, were found in this study. In addition, the adjusted odds of mortality between SIH (AOR = 0.3; 95% CI 0.03–2.99; p = 0.302) as well as DH patients (AOR = 0.6; 95% CI 0.20–1.89; p = 0.394) and DN patients had no significant difference. Conclusions: This study demonstrated that SIH and DH patients with traumatic femoral fractures had higher mortality when compared with NDN patients, but not when compared with DN patients, with or without adjustment of the differences in patient’s age, sex, co-morbidities, and injury severity.

Stress-Induced and Diabetic Hyperglycemia Associated with Higher Mortality among Intensive Care Unit Trauma Patients: Cross-Sectional Analysis of the Propensity Score-Matched Population

“…The prevalence rates of preexisting comorbidities, such as HTN, CAD and CVA, were significantly lower among patients with SIH than those patients with DH. With a higher ISS, the individuals with SIH (median (IQR, Q1–Q3), 24 [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]) had a significantly severe injury compared to those with NDN (16 [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]), DN (16 [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]) and DH (17 [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]). Compared with NDN, DH had a significantly higher ISS.…”

“…The severity of SIH is characterized by its higher rates of morbidity and mortality when compared with those without preexisting DM [ 13 , 15 , 16 , 22 , 23 ]. In the evaluation of the differential effect of SIH versus diabetic hyperglycemia (DH) on the outcomes of trauma patients, a significantly higher mortality rate had been reported in those patients with SIH, but not with DH [ 8 , 24 , 25 , 26 ]. The mortality risk was two-fold higher in patients with SIH than the DH patients, whose mortality risk did not significantly increase [ 8 ].…”

Association of Stress-Induced Hyperglycemia and Diabetic Hyperglycemia with Mortality in Patients with Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population

“…DH and SIH are diagnosed when serum glucose concentrations are ≥200 mg/dL in patients with and without diabetes mellitus (DM), respectively [5]. A stress response can commonly induce a form of SIH in patients with critical illnesses such as TBI [6][7][8], myocardial infarction [9], femoral fracture [10], or major trauma [11][12][13][14]. Unlike DH, which is a chronic process associated with microvascular changes in cases of prolonged hyperglycemia [15], SIH occurs secondary to increased hepatic output of glucose.…”

Survival Analysis of Hospitalized Elderly People with Fractures in Brazil Over One Year

“…Elderly patients with DM presented a lower probability of survival, an association that has been established in the literature [23,24]. Fractures are stressful events to the organism and induce hyperglycemia and insulin resistance.…”

“…Consequently, glycemic control becomes difficult to maintain in the in-hospital environment. This glycemic instability can alter bone remodeling mechanisms, which may hamper or minimize the time needed for bone healing in diabetic elderly patients with fractures, thereby increasing the risk of mortality [23]. Given the higher prevalence of diabetes worldwide [25] and that exposure to hyperglycemia may increase deaths in elderly with fractures, prevention and control measures must be reinforced in different sectors of the health area, including in hospitalized patients, when glycemic control is essential for bone repair and, consequently, better rehabilitation for the elderly.…”