Admission Hyperglycemia in Head Injured Patients
AbstractHyperglycemia, in trauma patient, is commonly associated with a hyper metabolic stress response. Our objective is to determine the effects of hyperglycemia on the overall outcome of head trauma patients. In this descriptive study data were collected from head trauma patients' admitted to Intensive Care Unit (ICU) of Poursina University Hospital in a one-year period (Jan 2004-Jan 2005), retrospectively. All patients had stayed in the ICU for more than 48 hours post-injuries. They were divided into two groups according to their serum glucose levels at the time of admission (<200mg/dl or >200mg/dl), age, gender and Injury Severity Score (ISS). Patients with diabetes mellitus were excluded .We determined the outcome according to duration of hospitalization and ICU stay as well as mortality rates. Variables were analyzed with t-test and chi square test. Out of 115 patients, 89.6% were men. About 36 % of patients had serum glucose levels ≥ 200 mg/dl over the study period and this group had significantly greater mortality rate but without necessarily longer ICU or hospital stay. In this study we have shown that admission hyperglycemia has significant effect on patient's mortality but it is still unclear whether it can be a cause for longer ICU/hospital stay.© 2009 Tehran University of Medical Sciences. All rights reserved.
Senkowski CK, McKenney MG. Trauma scoring systems: a review. J Am Coll Surg 1999; 189(5): 491-503.
Van Camp LA, Delooz HH. Current trauma scoring systems and their applications. Eur J Emerg Med 1998; 5(3): 341-53.
Lannoo E, Van Rietvelde F, Colardyn F, Lemmerling M,Vandekerckhove T, Jannes C, et al. Early predictors of mortality and morbidity after severe closed head injury. J Neurotrauma 2000; 17(5): 403-14.
Graf WD, Cummings P, Quan L, Brutocao D. Predicting outcome in pediatric submersion victims. Ann Emerg Med 1995; 26(3): 312-9.
Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M. Association of hyperglycemia with increased mortality after severe burn injury. J Trauma 2001; 51(3): 540-4.
Pomposelli JJ, Baxter JK 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, et al. Early postoperativeglucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr 1998; 22(2):77-81.
Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997; 63(2): 356-61.
Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 1999; 22(9): 1408-14.
Demerdash TM, Seyrek N, Smogorzewski M, MarcinkowskiW, Nasser-Moadelli S, Massry SG. Pathways through which glucose induces a rise in [Ca2+]i of polymorphonuclearleukocytes of rats. Kidney Int 1996; 50(6): 2032-40.
Hostetter MK. Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes 1990; 39(3): 271-5.
Kjersem H, Hilsted J, Madsbad S, Wandall JH, Johansen KS, Borregaard N. Polymorphonuclear leucocyte dysfunctionduring short term metabolic changes from normo- to hyperglycemia in type 1 (insulin dependent) diabetic patients. Infection 1988; 16(4): 215-21.
Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 2005; 59(1): 80-3.
Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002; 87(3): 978-82.
Hirsch IB. In-patient hyperglycemia: are we ready to treat it yet? J Clin Endocrinol Metab 2002; 87(3): 975-7.
Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355(9206): 773-8.
Yendamuri S, Fulda J, Tinkoff G. Admission hyperglycemia as a prognostic indicator in trauma. J Trauma 2003; 55:33-38.
Bochicchio GV, Sung J, Joshi M, Bochicchio K, Johnson SB, Meyer W, et al. Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 2005; 58(5): 921-4.
Bochicchio GV, Salzano L, Joshi M, Bochicchio K, Scalea TM. Admission preoperative glucose is predictive of morbidity and mortality in trauma patients who require immediate operative intervention. Am Surg 2005; 71(2): 171-4.
Mizock BA. Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med 1995; 98(1): 75-84.
Bagdade JD, Root DA, Bulger RJ. Impaired leukocyte function in patients with poorly controlled diabetes. Diabetes 1974; 23(1): 9-15.
Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003; 78(12): 1471-8.
Walia S, Sutcliffe AJ. The relationship between blood glucose, mean arterial pressure and outcome after severe head injury: an observational study. Injury 2002; 33(4):339-44.