The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

Geon Ho Lee; Byeong Cheol Rim; Kyung Soo Min; Mou Seop Lee; Young Gyu Kim; Dong Ho Kim

doi:10.13004/jknts.2010.6.1.23

Journal List > J Korean Neurotraumatol Soc > v.6(1) > 1084074

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Lee, Rim, Min, Lee, Kim, and Kim: The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

Clinical Article

Journal of Korean Neurotraumatology Society 2010; 6(1): 23-26.

Published online: 30 June 2010

DOI: https://doi.org/10.13004/jknts.2010.6.1.23

The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

Geon Ho Lee, MD, Byeong Cheol Rim, MD, PhD, Kyung Soo Min, MD, PhD, Mou Seop Lee, MD, PhD, Young Gyu Kim, MD, PhD, Dong Ho Kim, MD, PhD

Department of Neurosurgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Address for correspondence: Dong Ho Kim, MD, PhD. Department of Neurosurgery, Chungbuk National University College of Medicine, 410 Seongbong-ro, Gaesin-dong, Heungdeok-gu, Cheongju 361-711, Korea. Tel: +82-43-269-6087, Fax: +82-43-273-1614, dhkim@chungbuk.ac.kr

Received 10 May 2010 Revised 10 May 2010 Accepted 18 May 2010

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.

Keywords: Hyperglycemia, Traumatic brain injury, Prognosis

Figures and Tables

TABLE 1

General characteristics of patients (n=68)

ISS: injury severity score, AIS: abberviated injury scale, GCS: Glasgow Coma Scale, ICU: intensive care unit, BMI: body mass index

TABLE 2

Comparison of patients according to serum glucose level

ISS: injury severity score, AIS: abberviated injury scale, GCS: Glasgow Coma Scale, ICU: intensive care unit, BMI: body mass index

TABLE 3

Infection morbidity and mortality of patients according to serum glucose level

TABLE 4

Correlation between variables and infection morbidity and mortality on univariate logistic regression

ISS: injury severity score, AIS: abberviated injury scale, GCS: Glasgow Coma Scale, ICU: intensive care unit, BMI: body mass index

Notes

This work was supported by the research grant of the Chungbuk National University in 2008.

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