Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population

Abstract

Purpose Serum markers of inflammation and of glucose production are known to reflect the immediate metabolic response to injury. We hypothesized that monitoring of the early C-reactive protein (CRP) and blood glucose (BG) concentrations would correlate with clinical morbidity and outcome measures in pediatric trauma patients. Methods A five-year retrospective chart review of pediatric trauma patients admitted to our Level I pediatric trauma center was conducted to establish the relationships between early (first 3 hospital days) serum CRP and BG concentrations, Injury Severity Score (ISS), and hospital length of stay (HLOS). Statistical significance ( P < 0.05) was determined using Student’s t-test. Results Forty-two trauma patients (8.0 ± 5.2 years) were evaluated. The early inflammatory response (CRP ≥ 10 vs <10 mg/dl) was significantly correlated to the glycemic response (BG;121 ± 24 vs 97.3 ± 14.2 mg/dl, P < 0.05). Severely injured patients (ISS ≥ 25 vs <25) were significantly more hyperglycemic (BG;156 ± 56.9 vs 125 ± 31.6 mg/dL, P = 0.003). Both increased inflammatory response (CRP;8.1 ± 6.4 vs 2.5 ± 3.5 mg/dL) and increased glycemic response (BG;111 ± 15.9 vs 97.4 ± 11.7 mg/dL) were independently and significantly associated with prolonged hospitalization (HLOS > 7 vs ≤7 days, P < 0.05). Conclusion This study establishes a significant relationship between the early inflammatory and glycemic injury response and the association of that response with pediatric trauma patient morbidity and outcome measures.