Elan Jeremitsky MD, Laurel Omert MD*, C. Michael Dunham MD*, Jack Wilberger MD, Aurello Rodriguez MD* Department of Surgery, Allegheny General Hospital, Pittsburgh, PA

Objective: There is increasing data to suggest that hyperglycemia correlates with worse outcome in critically ill patients. The purpose of this study is to analyze the relationship of hyperglycemia with early outcome in severe traumatic brain injury (TBI) and to elucidate possible factors that may be responsible for the hyperglycemic state.

Methods: Patients admitted to a Level I trauma center with severe TBI and who survived for >5 days were retrospectively reviewed. Daily serum glucose, base deficit (BD), GCS, use of steroids, and amounts of insulin and carbohydrates were recorded for 5 days. A hyperglycemia score (HS) was calculated wherein a value of 1 was assigned each day the glucose was > 170 mg/dL (range 0-5).

Results: Twenty four of 77 patients died (31.2%). Glucose levels were higher in the non-survivors: day 1 - 210+72 vs 178+62, day 2 - 201+60 vs 189±68, day 3 - 174±50 vs 149±30, day 4 - 163+55 vs 150±40, day 5 - 186+93 vs 152+42. HS was higher in those who died: (2.4±1.7 vs 1.5.-1.4; p=0.02). The table illustrates variables associated with worse outcomes.

	HS	Age	ISS	BD	AIS: head I/chest/abd
Mortality	p=0.02	p<0.01	p<0.01	p=0.03
GCS day 5	p=0.01		p<0.01		p=0.01/0.03/<0.01
ICU LOS	p=0.01		p=0.01	p=0.02	p=0.01/0.03/0.02
Total LOS	p=0.02		p=0.03		p<0.01

Multivariate regression analysis revealed that mortality was related to HS, ISS and BD (p<0.05). GCS day 5 was independently associated with HS and AIS head (p<0.05). ICU and total LOS were independently related to HS and ISS (p<0.05). A higher HS was associated with age, steroids, diabetes and lower GCS day 5, while carbohydrate Infusion (mg/kg/min), ISS, and AIS head were not.

Conclusions: Early hyperglycemia is associated with poor outcomes for patients with severe TBI. Tighter control of serum glucose without reducing nutritional support may be shown to improve the prognosis of these critically ill patients.



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