Association between Blood Glucose Levels the Day after Targeted Temperature Initiation and Outcome in Traumatic Brain Injury: A Post-Hoc Analysis of the B-HYPO Study.
We investigated associations between blood glucose levels and clinical outcomes in participants of the multi-center randomized controlled Brain-Hypothermia (B-HYPO) study. Patients with severe traumatic brain injury (TBI, Glasgow Coma Scale 4-8) were assigned to therapeutic hypothermia (TH, 32-34°C, n = 98) or fever control (35.5-37.0°C, n = 50) groups. TH patients were cooled as soon as possible for ≥72 h and rewarmed at a rate of <1°C/d. We recorded blood glucose (BG) levels on days 0, 1, and 3 after treatment initiation, and day 1 after rewarming. The Glasgow Outcome Scale was assessed at 6 months. Median BG levels decreased from day 0 to day 1 (163 vs. 132 mg/dL, p = 0.0062) in the fever control group. In contrast, a decrease was observed from day 1 to day 3 (157.5 vs. 126 mg/dL, p < 0.001) in the TH group. Day 1 BG was higher in the TH group compared with the fever control group (p = 0.0252). At day 0, BG levels were higher in non-survivors compared with survivors across all patients (p = 0.0035), the TH group (p = 0.0125), and the non-surgical group (p = 0.0236). Higher day 1 BG levels were observed in non-survivors compared with survivors across all patients (p = 0.0071), the fever control group (p = 0.0495), and the surgical group (p = 0.0364). In the TH group, the initial stress hyperglycemia was sustained the next day after TH induction. Day 1 BG predicted outcome in TBI patients with TH and fever control. Our findings indicate the significance of BG control particularly during TH treatment.
1 Osaka Mishima Emergency Critical Care Center , Osaka, Japan .
Hitoshi
H
Kobata
1 Osaka Mishima Emergency Critical Care Center , Osaka, Japan .
Akira
A
Sugie
2 Department of Neurosurgery, Yamaguchi University School of Medicine , Yamaguchi, Japan .
Eiichi
E
Suehiro
3 Department of Emergency Medicine, The Jikei University , Tokyo, Japan .
Kenji
K
Dohi
4 Emergency and General Medicine, Kumamoto University Hospital , Kumamoto, Japan .
Tadashi
T
Kaneko
5 Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital , Yamaguchi, Japan .
Motoki
M
Fujita
5 Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital , Yamaguchi, Japan .
Yasutaka
Y
Oda
6 Department of Emergency Medicine, Kagawa University School of Medicine , Kagawa, Japan .
Yasuhiro
Y
Kuroda
7 Emergency and Critical Care Center , Tokuyama Central Hospital, Yamaguchi, Japan .
Susumu
S
Yamashita
8 Yamaguchi Prefectural Grand Medical Center , Yamaguchi, Japan .
Takeshi
T
Maekawa
D000328:Adult; D000359:Aftercare; D001786:Blood Glucose / Q000378:metabolism*; D000070642:Brain Injuries, Traumatic / Q000097:blood* / Q000628:therapy*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000209:etiology; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017694:Rewarming / Q000379:methods; D017741:Survivors; D013997:Time Factors; D055815:Young Adult
D001786:Blood Glucose
hyperglycemia; outcome; targeted temperature management; therapeutic hypothermia; traumatic brain injury