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Early dysglycemia and mortality in traumatic brain injury and subarachnoid hemorrhage

Simone Pappacena1, Michael Bailey2, Luca Cabrini1

  • 1Department of Anesthesiology and Intensive Care, San Raffaele Hospital, Milan, Italy.

Minerva Anestesiologica
|February 9, 2019
PubMed

Insights

Greater blood sugar fluctuations (dysglycemia) increase mortality risk in patients with traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH). This risk is higher in TBI and SAH patients compared to the general ICU population.

Area of Science:

  • Intensive Care Medicine
  • Neurology
  • Endocrinology

Background:

  • Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are leading causes of acute brain injury in young ICU patients.
  • Dysglycemia, encompassing abnormal blood glucose levels, is prevalent in these patients.
  • The comparative impact of different dysglycemia aspects on outcomes in TBI and SAH is not well understood.

Purpose of the Study:

  • To investigate the association between early dysglycemia and mortality in TBI and SAH patients.
  • To compare the impact of dysglycemia on mortality between TBI and SAH patients.
  • To compare the dysglycemia-mortality relationship in TBI and SAH patients with the general ICU population.

Main Methods:

  • Retrospective, cross-sectional study of adult ICU admissions in Australia and New Zealand (2005-2015).
  • Analysis of early (first 24 hours) dysglycemia metrics: peak, variability, mean, and nadir glycemia.
  • Statistical adjustment for illness severity to assess mortality associations.

Main Results:

  • Increased mortality was associated with each quintile of glycemia for all measured aspects of dysglycemia (P<0.0001).
  • The increased mortality risk from dysglycemia was significantly greater in TBI and SAH patients than in the general ICU population.
  • The association between dysglycemia and mortality was significantly stronger in TBI patients compared to SAH patients (P<0.0001).

Conclusions:

  • Greater dysglycemia is significantly associated with increased mortality in TBI and SAH patients.
  • This association is more pronounced in TBI and SAH patients than in the general ICU population.
  • The mortality risk linked to dysglycemia is significantly higher in TBI patients than in SAH patients.
Abstract

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