Hyperglycemia: A Predictor of Death in Severe Head Injury Patients.
OBJECTIVE
Management of hyperglycemia during an acute sickness in adults is accompanied by improved outcomes. We have designed a prospective study with meticulous attention to exclude all diabetes patients by checking hemoglobin A1c (HbA1c or glycated hemoglobin) to avoid the ill-effects of hyperglycemia in patients with traumatic head injury admitted to the intensive care unit (ICU).


METHODS
This prospective study included adults with traumatic primary brain injury with a Glasgow coma score of ≤8 necessitating mechanical ventilation treated in the period 2012-2015. After screening 311 patients, 220 were included in the study. Both blood glucose and HbA1c levels of all the patients at admission, as well as blood glucose level after 72 hours, were obtained from the records. The patients were later grouped based on their admission blood glucose levels (<200 mg/dL or ≥200 mg/dL). Injury severity score (ISS) was documented for every patient. As a final point, the outcomes were determined based on the hospital length of stay (HLS) and ICU length of stay (ILS), plusmortality rates.


RESULTS
About 39% (n= 85) of patients were admitted with hyperglycemia during the study period. The mortality rate in patients with glucose ≥200 mg/dL was 65.8% (N= 56), against 23.7% (N= 32) in the group with glucose <200 mg/dL, with mortality rising as the blood glucose level increased (P= 0.014).


CONCLUSIONS
We conclude that admission hyperglycemia is related with increased mortality rate in head injury patients, and comprehensive treatment of hyperglycemia can improve the outcome of severe head injury patients.
MD, Mazandaran University of Medical Science.
Simin Babaie
SB
Kafaki
MD, Mazandaran University of Medical Science.
Kamaledin
K
Alaedini
MD, School of Medicine, Mazandaran University of Medical Science, Sari, Iran.
Ashkan
A
Qorbani
MD, Mazandaran University of Medical Science.
Leila
L
Asadian
Associated Professor, Department of Neurosurgery, Diabetes Research Center, Emam Hospital, Diabetes Research Center, Mazandaran University of Medical Science, Sari, Iran.
Kaveh
K
Haddadi
hyperglycemia; injury severity score; mortality
J Neurosurg. 1987 Jun;66(6):875-82
3572517
J Trauma. 2005 May;58(5):921-4
15920404
Eur J Emerg Med. 1998 Sep;5(3):341-53
9827839
Am J Med. 1995 Jan;98(1):75-84
7825623
Ann Neurol. 1987 May;21(5):438-43
3592639
Injury. 1979 Feb;10(3):201-8
759367
Ann Surg. 1989 Oct;210(4):466-72; discussion 472-3
2679455
Mayo Clin Proc. 2003 Dec;78(12):1471-8
14661676
Surg Neurol. 1995 Oct;44(4):373-7
8553258
JPEN J Parenter Enteral Nutr. 1998 Mar-Apr;22(2):77-81
9527963
Acta Neurochir (Wien). 2008 May;150(5):461-9; discussion 470
18421408
J Trauma. 2005 Jul;59(1):80-3
16096543
J Trauma. 2001 Sep;51(3):540-4
11535907
Diabetes Care. 1999 Sep;22(9):1408-14
10480501
Am Surg. 2005 Feb;71(2):171-4
16022019
J Trauma Acute Care Surg. 2015 Aug;79(2):289-94
26218699
Lancet. 2000 Mar 4;355(9206):773-8
10711923
N Engl J Med. 2001 Nov 8;345(19):1359-67
11794168
Neurosurgery. 1981 Jan;8(1):10-4
7207763
J Trauma. 2003 Jul;55(1):33-8
12855878
J Neurotrauma. 2000 May;17 (5):403-14
10833059
Infection. 1988 Jul-Aug;16(4):215-21
2846445
Diabetes. 1974 Jan;23(1):9-15
4809622
Crit Care Med. 2000 Jan;28(1):16-8
10667493
Injury. 1984 May;15(6):397-402
6724685
J Am Coll Surg. 1999 Nov;189(5):491-503
10549738
Acta Neurochir (Wien). 1999;141(3):223-36
10214478