Hyperglycemia and Outcomes after Acute Traumatic Spinal Cord Injury: Scoping Review

Hyperglycemia is a recognized prognostic marker in neurocritical care, but condition-specific data and glycemic targets for traumatic spinal cord injury (TSCI) remain undefined. We conducted a scoping review to map how early hyperglycemia has been defined and measured in adults with acute TSCI and how it relates to neurological and functional outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews guidance, PubMed, Embase, and Scopus were searched from inception to November 2025 for studies enrolling adults (≥18 years) within 7 days of TSCI, defining hyperglycemia at ≥126 mg/dL, and reporting neurological, functional, or mortality outcomes. Eligible designs included prospective and retrospective cohorts and registry-based analyses; pediatric, diabetic-only, nontraumatic, animal, and chronic-phase studies were excluded. Of 2323 records, 6 observational studies (n = 2586) met the inclusion criteria. Most cohorts involved predominantly cervical injuries and used admission or 24-h glucose as the primary exposure. Across studies, more severe neurological impairment at presentation was associated with higher admission glucose, and admission hyperglycemia was generally linked to poorer motor recovery, lower Spinal Cord Independence Measurement scores, and unfavorable AIS profiles at discharge, although these associations frequently attenuated after multivariable adjustment. Overall, evidence on hyperglycemia in acute TSCI is limited, heterogeneous, and observational. Early hyperglycemia shows signals of association with adverse neurological and functional outcomes, but effect estimates are inconsistent and do not support specific glycemic targets. Glucose and composite indices remain candidate prognostic biomarkers that require validation in standardized, prospective multicenter cohorts before interventional trials can be justified.