Blood glucose levels at 24 hours after trauma fails to predict outcomes.
BACKGROUND
Blood glucose (BG) at admission correlates with lactate and outcomes. The purpose of this study was to determine whether this correlation continues at 24 hours.


METHODS
We studied 335 trauma patients correlating Injury Severity Score (ISS), lactate, and outcome parameters to BG at admission and 24 hours.


RESULTS
There were 134 patients at admission and 68 patients at 24 hours who had a high blood glucose (HBG) (>150 mg/dL). Admission HBG group had higher ISS (25.3 +/- 13.6 vs. 19.8 +/- 11.4, p = 0.0002, analysis of covariance p < 0.0001), longer lengths of stays (in days) (ventilator: 2.0 +/- 4.4 high blood sugar [HBS] vs. 0.8 +/- 2.5 low blood sugar [LBS], p = 0.0034; intensive care unit: 7.7 +/- 10.1 HBS vs. 4.6 +/- 7.5 LBS, p = 0.0001; hospital: 14.7 +/- 13.8 HBS vs. 9.8 +/- 11.6 LBS, p < 0.0001) and a higher mortality rate (15.67% [21 of 134] HBS vs. 7.46% [15 of 201] LBS, p = 0.02) compared with the LBS group. A significant linear relationship existed between ISS and blood sugar (r = 0.06, p < 0.0001) and ISS and lactate (r = 0.05, p < 0.0001). The Pearson correlation identified that blood sugar and lactate trended together (r = 0.3, p < 0.0001). Twenty-four-hour HBG failed to correlate with worse outcomes. With lactate </=2.2 mmol/L at 24 hours (n = 287), there was no difference in mortality between the HBG and LBG groups (9.8% [5 of 51] HBS vs. 6.36% [15 of 236] LBS, p = 0.37). In the LBG group at 24 hours (n = 267), there was a significant difference in mortality with a lactate >2.2 mmol/L group (35.5% [11 of 31] vs. 6.36% [15 of 236], p = 0.00003). Using logistic regression, only lactate at 24 hours (odds ratio 1.79, 95% confidence interval 1.259-2.546) and ISS (odds ratio 1.1, 95% confidence interval 1.06-1.15) were independently predictive of death.


CONCLUSIONS
BG levels at 24 hours do not correlate with outcome, particularly if the patient is adequately resuscitated with a normal lactate.
Duane
Therèse M
TM
Division of Trauma Critical Care and Emergency General Surgery, Virginia Commonwealth University Medical Center, Virginia, USA. tmduane@vcu.edu
Ivatury
Rao R
RR
Dechert
Tracey
T
Brown
Holly
H
Wolfe
Luke G
LG
Malhotra
Ajai K
AK
Aboutanos
Michel B
MB
D000328:Adult; D001786:Blood Glucose; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007773:Lactates / Q000097:blood* / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000097:blood* / Q000145:classification / Q000401:mortality
D001786:Blood Glucose; D007773:Lactates