Clinical Impact of Early Hyperglycemia During Acute Phase of Traumatic Brain Injury
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ORIGINAL ARTICLE
Clinical Impact of Early Hyperglycemia During Acute Phase of Traumatic Brain Injury Xi Liu-DeRyke Æ Dave S. Collingridge Æ James Orme Æ Dean Roller Æ John Zurasky Æ Denise H. Rhoney
Published online: 29 May 2009 Ó Humana Press Inc. 2009
Abstract Introduction While tight glucose control has been widely adopted in the critical care setting, the optimal target glucose level following acute traumatic brain injury (TBI) remains debatable. This observational study was conducted to delineate the relationship between glucose levels and clinical outcomes during acute phase (first 5 days) of TBI. Methods We retrospectively identified 429 TBI patients admitted to the intensive care unit (ICU) from January
X. Liu-DeRyke (&) Orlando Regional Medical Center, 1414 Kuhl Ave, MP 180, Orlando, FL 32806, USA e-mail: [email protected] D. S. Collingridge Statistical Data Center, LDS Hospital, 8th Ave & C Street, Salt Lake City, UT 84146, USA e-mail: [email protected] J. Orme Critical Care Medicine, LDS Hospital, 8th Ave & C Street, Salt Lake City, UT 84146, USA e-mail: [email protected] D. Roller J. Zurasky Neurovascular Medicine, LDS Hospital, 8th Ave & C Street, Salt Lake City, UT 84146, USA e-mail: [email protected] J. Zurasky e-mail: [email protected] D. H. Rhoney Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave, Detroit, MI 48201, USA
2005 to December 2006. Of those, 380 patients were retained for final analysis. Collected data included demographics, admission Glasgow Coma Scale (GCS), and APACHE II, glucose on admission and during the first 5 days of admission, and insulin use. Clinical outcomes included mortality, ICU, and hospital length of stay. Results The overall hospital mortality was 13.2% (n = 50). Demographics were similar between survivor and nonsurvivor groups; however, nonsurvivors were older and had worse disease severity on admission. Nonsurvivors also had significantly higher glucose levels at admission and during the first 24 h of admission (P < 0.001). Based on the receiver operating characteristic (ROC) curve, admission and day-1 peak glucose were better predictors for mortality compared to hospital days 2–5 glucose levels, with day-1 peak glucose being the best predictor of mortality (AUC = 0.820). A Kaplan–Meier survival analysis also showed that patients with glucose
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