The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

Abstract

Objective: According to a recent study, strict control of serum glucose level in patients result in decreased morbidity and mortality. But the clinical relationship of hyperglycemia in patients with severe traumatic brain injury (TBI) are controversial. So the purpose of this study was to evaluate the impact of hyperglycemia in patients with severe TBI. Methods: The authors performed a retrospective 68 chart reviews of severe TBI [Glasgow Coma Scale (GCS), score ≤8] who were admitted to the department of neurosurgery from January 2007 to December 2009. The age, sex, GCS score, injury severity score (ISS), initial serum blood glucose level, abbreviated injury score (AIS) head, length of stay in intensive care unit (ICU), body mass index (BMI) infection morbidity and mortality were mesured. The patients were divided into two groups by their serum glocose level (<200 mg/dL, ≥200 mg/dL). Patients with diabetes mellitus or below age of 18 was excluded from the study. Results: Patients’ age was from 19 to 84 years with a mean age of 53.7±19.17 years. There were 44 males (64.7%) and 24 females (35.3%). The average of GCS score was 5.3±1.8, ISS was 37.2±8.3, AIS was 5.3±0.7. Length of stay in ICU was 14.6±16.8 days, BMI was 22.3±2.9 and the average of serum blood glucose level was 197.4±72.9 mg/dL. Infection rate was 25% and death rate was 48.5%. Hyperglycemic group (≥200 mg/dL) had higher infection morbidity (13.2 vs. 11.7%, p<0.01) and mortality (28.0 vs. 20.1%, p<0.01) compared to nonhyperglycemic group. Univariate analysis showed that GCS score, length of ICU stays and hyperglycemia (≥200 mg/dL) was associated with infection morbidity and mortality (p<0.01). Conculusion: Initial hyperglycemia (≥200 mg/dL) is associated higher infection morbidity and mortality in patients with severe TBI. Strict control of early blood glucose level may be an important factor to improve outcomes of severe traumatic brain injury patients. (J Kor Neurotraumatol Soc 2010;6:23-26)