Relationship Between Admission Hyperglycemia and Neurologic Outcome of Severely Brain-Injured Patients

Abstract

Severe head injury is associated with a stress response that includes hyperglycemia, which has been shown to worsen outcome before or during cerebral ischemia. To better define the relationship between human head injury and hyperglycemia, glucose levels were followed in 59 consecutive brain-injured patients from hospital admission up to 18 days after injury. The patients who had the highest peak admission 24-hour serum glucose levels had the worse 18-day neurologic outcome (p = 0.01). Patients with peak 24-hour admission glucose levels greater than 200 mg/dL had a two-unit increase in Glasgow Coma Scale score while patients with admission peak 24-hour serum glucose levels less than or equal to 200 mg/dL had a four-unit increase in Glasgow Coma Scale score during the 18-day study period (p = 0.04). There was a significant relationship between 3-month and 1-year outcome and peak admission 24-hour serum glucose level (p = 0.02 and p = 0.02, respectively). Those patients with admission peak 24-hour serum glucose levels less than or equal to 200 mg/dL had a greater percentage of favorable outcome at 18 days, 3 months, and 1 year than those with admission peak 24-hour glucose levels greater than 200 mg/dL (p = 0.0007, p = 0.03, and p = 0.005, respectively). A significant relationship between admission peak 24-hour Glasgow Coma Scale score and 18-day, 3-month, and 1-year outcomes was found (p = 0.0001, p = 0.0002, and p = 0.0002, respectively). Patients with mean admission peak 24-hour Glasgow Coma Scale scores of 3.5, 6, and 10 had mean admission 24-hour peak serum glucose levels of 252 +/- 23.5, 219.1 +/- 19, and 185.8 +/- 21, respectively (p = 0.05). These relationships were not significantly altered when confounding variables such as the amount of glucose given over the initial 24-hour postinjury period, the presence of diabetes or multiple injuries, and whether patients were given steroids, dilantin, or insulin were statistically incorporated. These data suggest that admission hyperglycemia is a frequent component of the stress response to head injury, a significant indicator of severity of injury, and a significant predictor of outcome from head injury.

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

“…Findings from this study are similar to what has been reported in the literature to date, specifically that hyperglycemia is transient following acute TBI, and is indicative of severity of injury and associated with poor outcomes [2][3][4][8][9][10][11]. Not surprisingly, nonsurvivors in our study had a significantly lower admission GCS and higher glucose levels compared to those who survived.…”

“…Therefore, hyperglycemia is traditionally considered a stress response and a simple reflection of the severity of injury. An increased body of evidence suggests that hyperglycemia is associated with poor clinical outcomes, and thus may also have prognostic value after acute neurologic injury [1][2][3][4][5][6][7]. Several studies examining the relationship between the admission blood glucose level and neurologic outcomes have reported conflicting findings [1-3, 8, 9].…”

“…Several studies examining the relationship between the admission blood glucose level and neurologic outcomes have reported conflicting findings [1-3, 8, 9]. Additionally, various glucose levels (110-200 mg/dl) have been identified as indicators for severity of injury or poor outcomes following acute neurologic injury such as traumatic brain injury (TBI) [1][2][3][8][9][10][11]. Because of variable results reported in the literature, the recommendation for hyperglycemia management in neurological-injured patients is largely based on expert opinion.…”

Monitoring and treatment of severe traumatic brain injury

“…Следует избегать пере-ливания растворов глюкозы, поскольку повышение ее уровня в плазме влияет на исход травмы [9,10]. Гипергликемия -неблагоприятный прогностический фактор при госпитализации пострадавшего или в первые сутки его пребывания в отделении интенсив-ной терапии, а также в течение 6 мес после тяжелой ЧМТ [11][12][13].…”

“…Гипонатриемию отмечают у 17,4-33% пострадавших после тяжелой ЧМТ. По данным мета-анализа обследования 5270 пациентов, гипонатри-емия при их госпитализации прямо коррелирует с неблагоприятным исходом [11].…”