[Relationship between hyperglycemia following head injury and neurological outcome]

Severe head injury is associated with a stress response that includes hyperglycemia, which has been shown in both experimental and clinical studies to exacerbate the severity of brain injury during ischemic conditions. To define the relationship between serum glucose levels and the outcome of patients suffering from closed head injury, we retrospectively reviewed the clinical courses of 88 consecutive head-injured patients. The patients were divided into two groups according to their GCS score on admission: severely head-injured group (GCS score of 8 or less) in 36 patients; moderately head-injured group (GCS score of 9 to 12) in 52 patients. Severely head-injured group had significantly higher serum glucose levels than moderately head-injured group (mean +/- standard error of the mean; 201 +/- 4.6 mg/dl vs. 171.4 +/- 3.8 mg/dl) (p < 0.01). Patients who subsequently resulted in severe disability, vegetative state, or death had significantly higher serum glucose levels than patients who had good recovery or moderate disability (204.9 +/- 5.9 mg/dl vs. 162.9 +/- 5.1 mg/dl) (p < 0.01). Cases with a fatal clinical course were mostly associated with high glucose levels. All patients who showed a serum glucose level greater than 240 mg/dl on admission were dead. These data suggest that the hyperglycemia on admission is a frequent component of the stress response to head injury, a significant indicator of severity of injury and a potent predictor of the outcome from head injury.