title: Admission blood glucose predicted haemorrhagic shock in multiple trauma patients.
abstract: BACKGROUND
  Admission blood glucose is known to be a predictor for outcome in several disease patterns, especially in critically ill trauma patients. The underlying mechanisms for the association of hyperglycaemia and poor outcome are still not proven. It was hypothesised that hyperglycaemia upon hospital admission is associated with haemorrhagic shock and in-hospital mortality.
  
  
  METHODS
  Data was extracted from an observational trauma database of the level 1 trauma centre at Innsbruck Medical University hospital. Trauma patients (≥18 years) with multiple injuries and an Injury Severity Score ≥17 were included and analysed.
  
  
  RESULTS
  In total, 279 patients were analysed, of which 42 patients (15.1%) died. With increasing blood glucose upon hospital admission, the rate of patients with haemorrhagic shock rose significantly [from 4.4% (glucose 4.1-5.5mmol/L) to 87.5% (glucose >15mmol/L), p<0.0001]. Mortality was also associated with initial blood glucose [≤5.50mmol/L 8.3%; 5.51-7.50mmol/L 10.9%, 7.51-10mmol/L 12.4%; 10.01-15mmol/L 32.0%; ≥15.01mmol/L 12.5%, p=0.008]. Admission blood glucose was a better indicator for haemorrhagic shock (cut-off 9.4mmol/L, sensitivity 67.1%, specificity 83.9%) than haemoglobin, base excess, bicarbonate, pH, lactate, or vital parameters. Regarding haemorrhagic shock, admission blood glucose is more valuable during initial patient assessment than the second best predictive parameter, which was admission haemoglobin (cut-off value 6.5mmol/L (10.4g/dL): sensitivity 61.3%, specificity 83.9%).
  
  
  CONCLUSIONS
  In multiple trauma, non-diabetic patients, admission blood glucose predicted the incidence of haemorrhagic shock. Admission blood glucose is an inexpensive, rapidly and easily available laboratory value that might help to identify patients at risk for haemorrhagic shock during initial evaluation upon hospital admission.
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Electronic address: janett.kreutziger@uki.at.
authors.forename: Janett
authors.initials: J
authors.lastname: Kreutziger
authors.affiliation: Internship, General Hospital of Linz, Krankenhausstr. 9, 4020 Linz, Austria. Electronic address: Andreas.Rafetseder@akh.linz.at.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rafetseder
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Electronic address: simon.mathis@uki.at.
authors.forename: Simon
authors.initials: S
authors.lastname: Mathis
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Electronic address: volker.wenzel@uki.at.
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Electronic address: rene.attal@uki.at.
authors.forename: René
authors.initials: R
authors.lastname: El Attal
authors.affiliation: Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Electronic address: stefan.schmid@uki.at.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmid
mesh_terms: D001317:Austria / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism*; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications / Q000401:mortality; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000097:blood* / Q000150:complications / Q000401:mortality; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000097:blood* / Q000209:etiology / Q000401:mortality; D014193:Trauma Centers / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose
keywords: Admission blood glucose; Haemorrhagic shock; Multiple trauma; Outcome