Glucose variability negatively impacts long-term functional outcome in patients with traumatic brain injury

• Published in: Journal of critical care Vol. 27; no. 2; pp. 125 - 131
• Main Authors: Matsushima, Kazuhide, MD, Peng, Monica, BS, Velasco, Carlos, BS, Schaefer, Eric, MS, Diaz-Arrastia, Ramon, MD, PhD, Frankel, Heidi, MD, FACS, FCCM
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2012; Elsevier Limited
• Subjects: Adult; Analysis of Variance; Blood Glucose - analysis; Blood Glucose - metabolism; Brain Injuries - blood; Brain Injuries - rehabilitation; Critical Care; Female; Glucose; Glucose variability; Humans; Long-term functional outcome; Male; Middle Aged; Prospective Studies; Recovery of Function; Regression analysis; Retrospective Studies; Time Factors; Trauma; Traumatic brain injury; Treatment Outcome; Young Adult; Long-term functional outcome; Glucose variability; Traumatic brain injury
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2011.08.012

Abstract Purpose Significant glycemic excursions (so-called glucose variability) affect the outcome of generic critically ill patients but has not been well studied in patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of glucose variability on long-term functional outcome of patients with TBI. Material and Methods A noncomputerized tight glucose control protocol was used in our intensivist model surgical intensive care unit. The relationship between the glucose variability and long-term (a median of 6 months after injury) functional outcome defined by extended Glasgow Outcome Scale (GOSE) was analyzed using ordinal logistic regression models. Glucose variability was defined by SD and percentage of excursion (POE) from the preset range glucose level. Results A total of 109 patients with TBI under tight glucose control had long-term GOSE evaluated. In univariable analysis, there was a significant association between lower GOSE score and higher mean glucose, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL but not POE 80 to 110. After adjusting for possible confounding variables in multivariable ordinal logistic regression models, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL were significantly associated with lower GOSE score. Conclusions Glucose variability was significantly associated with poorer long-term functional outcome in patients with TBI as measured by the GOSE score. Well-designed protocols to minimize glucose variability may be key in improving long-term functional outcome.