Serum Glucose-To-Potassium Ratio as a Prognostic Predictor for Severe Traumatic Brain Injury

Shibata, Ami; Matano, Fumihiro; Saito, Nobuyuki; Fujiki, Yu; Matsumoto, Hisashi; Mizunari, Takayuki; Morita, Akio

doi:10.1272/jnms.jnms.2021_88-506

Cited by 13 publications

(17 citation statements)

References 23 publications

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“…The levels of potassium, base deficit, lactate, and glucose have been widely used as indicators of recovery from hemorrhagic shock (18–20), which are consistent with the data from this study. More improvements toward normal levels during the period of 15 to 30 min post-REBOA appear to be 100% predictive of long-term survival in this study.…”

Section: Discussionsupporting

confidence: 90%

Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage

Liu

Crawford

et al. 2021

Shock

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Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving technique for the management of lethal torso hemorrhage. Its benefit, however, must be weighed against the lethal distal organ ischemia-reperfusion injury (IRI). This study uses a novel direct gut cooling technique to manage the distal organ IRI. Methods: A rat lethal hemorrhage model was established by bleeding of 50% of the estimated total blood volume via inferior vena cava. A novel TransRectal Intra-Colon (TRIC) temperature management device was positioned in the descending colon either to maintain intra-colon temperature at 378C or 128C. The upper body temperature was maintained at as close to 378C as possible in both groups. A 2F Fogarty balloon catheter was inserted via the femoral artery into the descending thoracic aorta for the implementation of REBOA. After REBOA, the balloon was deflated, and the shed blood was returned. The temperature managements were continued for additional 180 to 270 min during the post-REBOA period. Results: All rats subjected to REBOA management of lethal hemorrhage at 378C had severe histopathological gut and abdominal organ IRI, severe functional deficits, and died within 24 h with 100% mortality. By contrast, directly cooling the colon to 108C to 128C with the novel TRIC device abolished mortality, and dramatically improved ABG parameters, prevented the abdominal organ injury, and reduced the functional deficits during the 7-day post-REBOA period. Conclusions: Direct trans-rectal colon cooling during REBOA management of lethal hemorrhage offers extraordinary functional improvement and amazing tissue protection, and abolishes mortality.

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Section: Discussionsupporting

confidence: 90%

Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage

Liu

Crawford

et al. 2021

Shock

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“…Among ABG parameters, the blood levels of potassium, base deficit, lactate, and glucose have been used as prognostic predictors or indicators of recovery from HS (28–30). Consistent with this general concept, the present study shows that these four parameters were altered the most during the post-HS period (Fig.…”

Section: Discussionmentioning

confidence: 99%

Intracolon Cooling Increases Survival Rate in the Rat Model of Lethal Hemorrhage

Arya,

Hu,

Chen

et al. 2023

Shock

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Background The objective of this study is to investigate whether Trans-Rectal Intra-Colon (TRIC) cooling can prolong the survival duration in a rat hemorrhagic shock (HS) model. Methods A lethal-HS was induced by bleeding 47% of the total blood volume. A TRIC device was placed into the colon to maintain the intra-colon temperature either at 37 °C (TRIC37°C) or TRIC10°C pos-HS. In the surface cooling (SC) rats, the body temperatures were maintained at the same level as the esophageal temperature of the TRIC10°C rats. A separated group of TRIC10°C rats were resuscitated (Res) at 90 minutes post-HS. A total six groups were: (i) Sham-TRIC37°C (n = 5); (ii) Sham-TRIC10°C (n = 5); (iii) HS-TRIC37°C (n = 5); (iv) HS-TRIC10°C (n = 6); (v) HS-SC (n = 6); and (vi) HS-TRIC10°C + Res (n = 6). Results An average post-HS survival time was 18.4 ± 9.4 minutes in HS TRIC37°C and 82 ± 27.82 minutes in the HS SC group. In striking contrast, the HS TRIC10°C group exhibited an average survival time of 150.2 ± 66.43 minutes. The post-HS blood potassium level rose significantly in the HS-TRIC37°C and HS-SC, whereas remained unchanged in the TRIC10°C groups. Post-HS intestinal damage occurred in HS-TRIC37°C and HS-SC groups but virtually absent in HS TRIC10°C groups. Following resuscitation at 90 min post-HS, all HS-TRIC10°C rats were fully recovered from the lethal HS. Conclusions TRIC10°C reversed the high blood potassium level, prevented the intestinal damage, and prolonged the survival duration by 6-fold relative to normothermia and by 2-fold compared to SC post-HS. All TRIC10°C rats were successfully resuscitated at 90 min post-HS.

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“…Having categorized patients according to their progress, a cutoff point of modified ranking scale (mRS) ≤3 was envisaged as a favorable outcome, and an mRS ≥4 was considered unfavorable. Furthermore, a value of 50 was decided as the cutoff point for the glucose-potassium ratio; this was established in previous articles, 16) and the value was adopted for its calculation simplicity and because of its proximity to the standard mean.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, a ratio based on serum glucose and potassium levels has been proposed with the aim of studying 2 instead of only one indicator, thus avoiding false positive test results that appear, for example, in patients with diabetes while analyzing serum glucose values. 16) This ratio includes one biomarker with a rapid serum peak level (potassium) and one with steady serum level (glucose). We studied the glucose-potassium ratio as a prognostic factor in TBI by conducting a retrospective analysis of patients admitted to our institution over a period of one year, diagnosed with moderate or severe TBI, and including some cases of patients with mild TBI who underwent surgery.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Glucose Potassium Ratio in the Management of Traumatic Brain Injury

Marini¹,

Sein

2023

Korean J Neurotrauma

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Objective Traumatic brain injury (TBI) has become a worldwide public health issue, raising concerns about which tool might be useful to guide initial management at hospital admission, especially to decide whether the patient would benefit from an opportune surgical intervention. Recently, the glucose-to-potassium ratio has more accurate predictive values than other biomarkers and is useful for its simplicity to obtain. To correlate each biomarker with the outcome for every patient with TBI. Methods The analysis included patients treated in a single institution between 2020 and 2021, diagnosed with mild TBI that required neurosurgery, moderate or severe TBI. Blood samples were obtained at admission, and the glucose-to-potassium ratio was calculated retrospectively. Then, these values and other variables were compared with the outcome at 6 and 12 months. Extracranial lesions that directly contributed to the outcome, a Glasgow Coma Scale of 3 and below, hemodynamic instability, and cardiac arrest were exclusion criteria. Results Forty-seven patients who reached the criteria were examined, 35 (74%) had a favorable outcome and 12 (26%) a poor one. The only biomarker significantly related to the outcome was the glucose-to-potassium ratio in both the bivariate and multivariate analysis ( p =0.04; odds ratio, 8.61; 95% confidence interval, 1.07–69.6). Conclusion An increase in the glucose-to-potassium ratio was the only biomarker associated with poor outcomes and increased mortality.

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Serum Glucose-To-Potassium Ratio as a Prognostic Predictor for Severe Traumatic Brain Injury

Cited by 13 publications

References 23 publications

Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage

Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage

Intracolon Cooling Increases Survival Rate in the Rat Model of Lethal Hemorrhage

The Role of the Glucose Potassium Ratio in the Management of Traumatic Brain Injury

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