Introduction/Aim: Recently, hemoglobin A1c (HbA1c) has been suggested as a predictor of mortality and poor clinical outcome in patients with trauma. The aim of this study was to evaluate the relationship between HbA1c values and clinical outcome in patients with traumatic brain injury (TBI). Methods: In a cross-sectional study, a total of 133 TBI patients referred to the emergency department of Imam Khomeini Hospital in Sari, Mazandaran, Iran were evaluated. After transferring the patients to the neurosurgery ward, their HbA1c, fasting blood glucose (FBG) and postprandial glucose (PPG) were measured. Also, patients' Glasgow Coma Scale (GCS) score was recorded at the time of admission, 24 hours after admission and at the time of discharge from the hospital. Results: The mean of GCS score of patients at the time of admission, 24 hours after admission, and at the time of discharge were 9.02 (2.09), 10.07 (2.16), and 12.98 (1.82), respectively. The mean GCS score of patients with HbA1c < 5.7% was significantly lower than of patients with HbA1c = 5.7 - 6.5% at the time of admission (p < 0.05). At 24 hours after admission, the mean GCS score of patients with HbA1c < 5.7% was significantly lower than in other groups (p < 0.05). However, at the time of discharge, the mean GCS score of patients with HbA1c > 6.5% was significantly lower than in patients with HbA1c = 5.7 - 6.5% (p < 0.05). Over time, the mean of GCS scores in all patients significantly increased (p < 0.001). Conclusion: According to the results of this study it seems that HbA1c measurements cannot provide clear information about the clinical outcome of patients with TBI.
References
1.
Jalloh I, Carpenter KLH, Helmy A, Carpenter TA, Menon DK, Hutchinson PJ. Glucose metabolism following human traumatic brain injury: methods of assessment and pathophysiological findings. Metabolic Brain Disease. 2015;30(3):615–32.
2.
Guo F, Shen H. Glycosylated Hemoglobin as a Predictor of Sepsis and All-Cause Mortality in Trauma Patients. Infection and Drug Resistance. Volume 14:2517–26.
3.
Dandapat S, Siddiqui FM, Fonarow GC, Bhatt DL, Xu H, Matsouaka R, et al. A paradoxical relationship between hemoglobin A1C and in-hospital mortality in intracerebral hemorrhage patients. Heliyon. 2019;5(5):e01659.
4.
Jiang Z, Wang J, Zhao P, Zhang L, Guo Y. HbA1c: High in acute cerebral infarction and low in brain trauma. Progress in Molecular Biology and Translational Science. 2019. p. 293–306.
5.
Cappa KA, Conger JC, Conger AJ. Injury severity and outcome: A meta-analysis of prospective studies on TBI outcome. Health Psychology. 30(5):542–60.
6.
hidayatulloh syarif. Dynamics of Serum Lactate and Glucose Level with Coagulation Factors in Moderate and Severe Traumatic Brain Injury. International Journal of Surgery and Medicine. 2020;(0):1.
7.
Kutter D, Thoma J. Hereditary spherocytosis and other hemolytic anomalies distort diabetic control by glycated hemoglobin. Clin Lab. 2006;52(9–10):477–81.
8.
Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A New Look at Screening and Diagnosing Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism. 2008;93(7):2447–53.
9.
Bao Y, Gu D. Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis. Frontiers in Neurology. 12.
10.
John J, Lionel KR, Sen N. Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit. Indian Journal of Critical Care Medicine. 2014;18(1):21–5.
11.
Hermanides J, Plummer MP, Finnis M, Deane AM, Coles JP, Menon DK. Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis. Critical Care. 2018;22(1).
12.
Gale SC, Crnp CS, Reilly PM, Schwab CW, Gracias VH. Poor Glycemic Control is Associated with Increased Mortality in Critically Ill Trauma Patients. The American SurgeonTM. 2007;73(5):454–60.
13.
Kreutziger J, Schlaepfer J, Wenzel V, Constantinescu MA. The Role of Admission Blood Glucose in Outcome Prediction of Surviving Patients With Multiple Injuries. Journal of Trauma: Injury, Infection & Critical Care. 2009;67(4):704–8.
14.
Salim A, Hadjizacharia P, Dubose J, Brown C, Inaba K, Chan LS, et al. Persistent Hyperglycemia in Severe Traumatic Brain Injury: An Independent Predictor of Outcome. The American SurgeonTM. 2009;75(1):25–9.
15.
Seyed Saadat SM, Bidabadi E, Seyed Saadat SN, Mashouf M, Salamat F, Yousefzadeh S. Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population. Child’s Nervous System. 2012;28(10):1773–7.
16.
Mastrototaro JJ. The MiniMed Continuous Glucose Monitoring System. Diabetes Technology & Therapeutics. 2000;2(supplement 1):13–8.
17.
Yuan Q, Liu H, Xu Y, Wu X, Sun Y, Hu J. Continuous Measurement of the Cumulative Amplitude and Duration of Hyperglycemia Best Predicts Outcome After Traumatic Brain Injury. Neurocritical Care. 2014;20(1):69–76.
18.
Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, et al. Differences in A1C by Race and Ethnicity Among Patients With Impaired Glucose Tolerance in the Diabetes Prevention Program. Diabetes Care. 2007;30(10):2453–7.
19.
Ma C, Wu X, Shen X, Yang Y, Chen Z, Sun X, et al. Sex differences in traumatic brain injury: a multi-dimensional exploration in genes, hormones, cells, individuals, and society. Chinese Neurosurgical Journal. 2019;5(1).
20.
Liu C, Xie J, Xiao X, Li T, Li H, Bai X, et al. Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma. International Journal of Medical Sciences. 2021;18(7):1639–47.
21.
Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology. 2017;16(12):987–1048.
22.
Crane PK, Gibbons LE, Dams-O’Connor K, Trittschuh E, Leverenz JB, Keene CD, et al. Association of Traumatic Brain Injury With Late-Life Neurodegenerative Conditions and Neuropathologic Findings. JAMA Neurology. 2016;73(9):1062.
23.
Barnes DE, Byers AL, Gardner RC, Seal KH, Boscardin WJ, Yaffe K. Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans. JAMA Neurology. 2018;75(9):1055.
24.
Fann JR, Ribe AR, Pedersen HS, Fenger-Grøn M, Christensen J, Benros ME, et al. Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study. The Lancet Psychiatry. 2018;5(5):424–31.
25.
Kenney K, Diaz-Arrastia R. Risk of Dementia Outcomes Associated With Traumatic Brain Injury During Military Service. JAMA Neurology. 2018;75(9):1043.
26.
Sugarman MA, McKee AC, Stein TD, Tripodis Y, Besser LM, Martin B, et al. Failure to detect an association between self‐reported traumatic brain injury and Alzheimer’s disease neuropathology and dementia. Alzheimer’s & Dementia. 2019;15(5):686–98.
27.
Fu TS, Jing R, Fu WW, Cusimano MD. Epidemiological Trends of Traumatic Brain Injury Identified in the Emergency Department in a Publicly-Insured Population, 2002-2010. PLOS ONE. 11(1):e0145469.
28.
Kaimal G, Walker MS, Herres J, French LM, DeGraba TJ. Observational study of associations between visual imagery and measures of depression, anxiety and post-traumatic stress among active-duty military service members with traumatic brain injury at the Walter Reed National Military Medical Center. BMJ Open. 2018;8(6):e021448.
29.
Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, et al. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury. JAMA Psychiatry. 2019;76(3):249.
30.
Wilson L, Stewart W, Dams-O’Connor K, Diaz-Arrastia R, Horton L, Menon DK, et al. The chronic and evolving neurological consequences of traumatic brain injury. The Lancet Neurology. 2017;16(10):813–25.
31.
Majdan M, Brazinova A, Rusnak M, Leitgeb J. Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models. Journal of Neurosciences in Rural Practice. 2017;08(01):020–9.
32.
Matovu P, Kirya M, Galukande M, Kiryabwire J, Mukisa J, Ocen W, et al. Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda. PeerJ. 9:e10589.
33.
Terzioglu B, Ekinci O, Berkman Z. Hyperglycemia is a predictor of prognosis in traumatic brain injury: Tertiary intensive care unit study. Journal of Research in Medical Sciences. 2015;20(12):1166.
34.
Shi J, Dong B, Mao Y, Guan W, Cao J, Zhu R, et al. Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget. 2016;7(43):71052–61.
35.
Bosarge PL, Shoultz TH, Griffin RL, Kerby JD. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury. Journal of Trauma and Acute Care Surgery. 2015;79(2):289–94.
36.
Kafaki SB, Alaedini K, Qorbani A, Asadian L, Haddadi K. Hyperglycemia: A Predictor of Death in Severe Head Injury Patients. Clinical Medicine Insights: Endocrinology and Diabetes. 2016;9:CMED.S40330.
37.
Jeremitsky E, Omert LA, Dunham CM, Wilberger J, Rodriguez A. The Impact of Hyperglycemia on Patients With Severe Brain Injury. The Journal of Trauma: Injury, Infection, and Critical Care. 2005;58(1):47–50.
38.
Svedung Wettervik T, Howells T, Ronne-Engström E, Hillered L, Lewén A, Enblad P, et al. High Arterial Glucose is Associated with Poor Pressure Autoregulation, High Cerebral Lactate/Pyruvate Ratio and Poor Outcome Following Traumatic Brain Injury. Neurocritical Care. 2019;31(3):526–33.
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