title: Persistent hyperglycemia in severe traumatic brain injury: an independent predictor of outcome.
abstract: In patients with severe traumatic brain injury (TBI), admission hyperglycemia is associated with poor outcome. The effect of persistent hyperglycemia (PH) on outcome in severe TBI, however, remains unknown. We performed a retrospective review of all blunt trauma patients with severe TBI (head Abbreviated Injury Score > or = 3) admitted to the intensive care unit at a Level I trauma center from January 1998 through December 2005. Admission and daily intensive care unit blood glucose levels up to the end of the first week were measured. PH was defined as an average daily blood glucose > or = 150 mg/dL on all days for the first week of the hospital stay. TBI patients with and without PH were compared with respect to baseline demographics, injury characteristics, and outcomes. Independent risk factors for mortality were identified using logistic regression analysis. One hundred and five (12.6%) out of 834 severe TBI patients had PH. Patients with PH were older, more severely injured, and had worse head injury compared with patients without PH. After adjusting for significant risk factors, PH was identified as an independent risk factor for mortality (odds ratio (OR): 4.91 [95% confidence interval (CI), 2.88-8.56, P < 0.0001]). PH is associated with significantly higher mortality rates in severe TBI patients.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. ali.salim@cshs.org
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Pantelis
authors.initials: P
authors.lastname: Hadjizacharia
authors.forename: Joseph
authors.initials: J
authors.lastname: Dubose
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Daniel
authors.initials: D
authors.lastname: Margulies
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome