Hyperglycemia and neurological outcome in patients with head injury

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✓ To examine the relationship between serum glucose and the outcome of patients suffering from head injury, the authors retrospectively reviewed the clinical course of 169 patients admitted for treatment to Harborview Medical Center (a regional trauma center). All patients underwent craniotomy for evacuation of intracranial hematoma and/or placement of a subarachnoid bolt for intracranial pressure monitoring under general anesthesia. Patients with a Glasgow Coma Scale (GCS) score of 8 or less had significantly higher serum glucose levels than patients with GCS scores of 12 to 15 (mean ± standard error of the mean 192 ± 7 mg/dl vs. 130 ± 8 mg/dl or 10.7 ± 0.4 mmol/liter vs. 7.2 ± 0.4 mmol/liter) (p < 0.0001). Patients who subsequently remained in a vegetative state or died had significantly higher glucose levels both on admission and postoperatively than patients who had good outcome or moderate disability (217 ± 12 mg/dl vs. 167 ± 6 mg/dl or 12.1 ± 0.7 mmol/liter vs. 9.3 ± 0.3 mmol/liter on admission, and 240 ± 16 mg/dl vs. 156 ± 5 mg/dl or 13.3 ± 0.9 mmol/liter vs. 8.9 ± 0.3 mmol/liter postoperatively) (p < 0.0001). Among the more severely injured patients (GCS score ≤ 8), a serum glucose level greater than 200 mg/dl (11.1 mmol/liter) postoperatively is associated with a significantly worse outcome (p < 0.01). The authors conclude that severely head-injured patients frequently develop hyperglycemia and the elevated serum glucose level may aggravate ischemic insults and worsen the neurological outcome in such patients.

Article Information

Address reprint requests to: Arthur M. Lam, M.D., Department of Anesthesiology, Harborview Medical Center, 325 9th Avenue, Seattle, Washington 98104.

© AANS, except where prohibited by US copyright law.



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    Serum glucose levels in patients with good outcome vs. patients with poor outcome. Patients with Glasgow Outcome Scale score (GOS) 4/5 (vegetative/dead) have significantly higher serum glucose values than patients with GOS 1/2 (good/moderate disability (mod dis)), both during admission and postoperatively. Numbers in bars denote the actual number of patients in that category.

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    Outcome of patients with a Glasgow Coma Scale score of 8 or less categorized according to their postoperative glucose values (in mg/dl). Patients with postoperative glucose levels > 150 mg/dl or > 200 mg/ dl (right) had significantly worse outcome than patients with lower values. There was a higher proportion of patients with poor outcome in both hyperglycemic groups. Numbers in bars denote the actual number of patients in that category.

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    Outcome of patients with a Glasgow Coma Scale score of 8 or less categorized according to their admission glucose values (in mg/dl). Patients with admission glucose levels > 150 mg/dl (left) had significantly worse outcome than patients with glucose levels < 150 mg/dl. There was a higher proportion of patients with poor outcome in the group with glucose levels > 150 mg/dl but not in those with glucose levels > 200 mg/dl (right). Numbers in bars denote the actual number of patients in that category.



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