Introduction: This present study focuses on the findings of clinical trials that have revealed unsatisfactory results and mortality escalation rates of patients suffering from serious traumatic brain injuries (TBI). Aim: The main objective of this research was to investigate whether hyperglycaemia is a significant indicator of mortality in patients with the diagnosis of severe TBI. Methods: The research was performed using meta-analysis. The research material was collected throughout PubMed, Cochrane, NCBI, and Google Scholar from 2010 to 2020. Results: The research subjects were patients with TBI, proven to have hyperglycaemia on admission (random blood sugar evaluation > 200 mg/dl on arrival at the emergency department), with or without a history of DM (HbA1C evaluation ≥ 6.5%), a Glasgow Coma Scale score ≤ 8, and aged 0 - 100 years. The pooled risk ratio (RR) for mortality in severe TBI with hyperglycaemia on admission was 2.39. The evidence of mortality appeared significantly greater in patients with TBI with hyperglycaemia on admission than in those with normal blood glucose levels (RR = 2.39, p < 0.00001). The pooled RR had wide heterogeneity (I2 = 0.87), so the random-effect model was used. Conclusion: Hyperglycaemia on admission is often associated with unsatisfactory clinical outcomes and greater mortality.
References
1.
Laird AM, Miller PR, Kilgo PD, Meredith JW, Chang MC. Relationship of Early Hyperglycemia to Mortality in Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care. 2004;56(5):1058–62.
2.
Palmer AM, Marion DW, Botscheller ML, Swedlow PE, Styren SD, DeKosky ST. Traumatic Brain Injury‐Induced Excitotoxicity Assessed in a Controlled Cortical Impact Model. Journal of Neurochemistry. 1993;61(6):2015–24.
3.
Bullock R, Zauner A, Woodward JJ, Myseros J, Choi SC, Ward JD, et al. Factors affecting excitatory amino acid release following severe human head injury. Journal of Neurosurgery. 1998;89(4):507–18.
4.
Nishizawa Y. Glutamate release and neuronal damage in ischemia. Life Sciences. 2001;69(4):369–81.
5.
LUCAS DR, NEWHOUSE JP. The Toxic Effect of Sodium L-Glutamate on the Inner Layers of the Retina. Archives of Ophthalmology. 1957;58(2):193–201.
6.
Rovegno M, Soto PA, Sáez JC, von Bernhardi R. Biological mechanisms involved in the spread of traumatic brain damage. Medicina Intensiva (English Edition). 2012;36(1):37–44.
7.
Wieloch T, Nikolich K. Mechanisms of neural plasticity following brain injury. Current Opinion in Neurobiology. 2006;16(3):258–64.
8.
Kumar A, Loane DJ. Neuroinflammation after traumatic brain injury: Opportunities for therapeutic intervention. Brain, Behavior, and Immunity. 2012;26(8):1191–201.
9.
Pytel P, Alexander JJ. Pathogenesis of septic encephalopathy. Current Opinion in Neurology. 2009;22(3):283–7.
10.
Diringer MN, Scalfani MT, Zazulia AR, Videen TO, Dhar R, Powers WJ. Effect of Mannitol on Cerebral Blood Volume in Patients With Head Injury. Neurosurgery. 2012;70(5):1215–9.
11.
Chesnut RM. Care of Central Nervous System Injuries. Surgical Clinics of North America. 2007;87(1):119–56.
12.
Alluri H, Wiggins-Dohlvik K, Davis ML, Huang JH, Tharakan B. Blood–brain barrier dysfunction following traumatic brain injury. Metabolic Brain Disease. 2015;30(5):1093–104.
13.
Nov O, Kohl A, Lewis EC, Bashan N, Dvir I, Ben-Shlomo S, et al. Interleukin-1β May Mediate Insulin Resistance in Liver-Derived Cells in Response to Adipocyte Inflammation. Endocrinology. 2010;151(9):4247–56.
14.
Yendamuri S, Fulda GJ, Tinkoff GH. Admission Hyperglycemia as a Prognostic Indicator in Trauma. The Journal of Trauma: Injury, Infection, and Critical Care. 2003;55(1):33–8.
15.
Sorensen L, Siddall PJ, Trenell MI, Yue DK. Differences in Metabolites in Pain-Processing Brain Regions in Patients With Diabetes and Painful Neuropathy. Diabetes Care. 2008;31(5):980–1.
16.
Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission Hyperglycemia Is Predictive of Outcome in Critically Ill Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care. 2005;59(1):80–3.
17.
Losser MR, Damoisel C, Payen D. Bench-to-bedside review: Glucose and stress conditions in the intensive care unit. Critical Care. 2010;14(4):231.
18.
Malfitano C. Impact of conditioning hyperglycemic on myocardial infarction rats: Cardiac cell survival factors. World Journal of Cardiology. 2014;6(6):449.
19.
Marik PE, Bellomo R. Stress hyperglycemia: an essential survival response! Critical Care. 2013;17(2):305.
20.
Heyland DK, MacDonald S, Keefe L, Drover JW. Total Parenteral Nutrition in the Critically Ill Patient. JAMA. 1998;280(23):2013.
21.
van Der Voort PHJ, Feenstra RA, Bakker AJ, de Heide L, Boerma EC, van Der Horst ICC. Intravenous glucose intake independently related to intensive care unit and hospital mortality: an argument for glucose toxicity in critically ill patients. Clinical Endocrinology. 2006;64(2):141–5.
22.
Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine. 2011;365(6):506–17.
23.
Peppa M, A. Raptis S. Glycoxidation and Wound Healing in Diabetes: An Interesting Relationship. Current Diabetes Reviews. 2011;7(6):416–25.
24.
Hill J, Zhao J, Dash PK. High Blood Glucose Does Not Adversely Affect Outcome in Moderately Brain-Injured Rodents. Journal of Neurotrauma. 2010;27(8):1439–48.
25.
Krinsley JS, Meyfroidt G, van den Berghe G, Egi M, Bellomo R. The impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients. Current Opinion in Clinical Nutrition and Metabolic Care. 2012;15(2):151–60.
26.
Longstreth WT, Inui TS. High blood glucose level on hospital admission and poor neurological recovery after cardiac arrest. Annals of Neurology. 1984;15(1):59–63.
27.
Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F. Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. The American Journal of Medicine. 1983;74(4):540–4.
28.
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.
29.
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.
30.
Surgeons AC. Committee on Trauma. Advanced Trauma Life Support : Student Course Manual. 2018.
31.
Marshall LF. Head Injury: Recent Past, Present, and Future. Neurosurgery. 2000;47(3):546–61.
32.
Kaur P, Sharma S. Recent Advances in Pathophysiology of Traumatic Brain Injury. Current Neuropharmacology. 2018;16(8):1224–38.
33.
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.
34.
Pentelényi T, Kammerer L, Péter F, Fekete M, Korányi L, Stützel M, et al. Prognostic Significance of the Changes in the Carbohydrate Metabolism in Severe Head Injury. Proceedings of the 6th European Congress of Neurosurgery. 1979. p. 103–7.
35.
Pentelényi T, Kammerer L, Stützel M, Balázsi I. Alterations of the basal serum insulin and blood glucose in brain-injured patients. Injury. 1979;10(3):201–8.
36.
King LR, Knowles HC, McLaurin RL, Lewis HP. Glucose Tolerance and Plasma Insulin in Cranial Trauma. Annals of Surgery. 1971;173(3):337–43.
37.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews. 2015;4(1).
38.
Melo JRT, Di Rocco F, Blanot S, Laurent-Vannier A, Reis RC, Baugnon T, et al. Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury. Acta Neurochirurgica. 2010;152(9):1559–65.
39.
Smith RL, Lin JC, Adelson PD, Kochanek PM, Fink EL, Wisniewski SR, et al. Relationship between hyperglycemia and outcome in children with severe traumatic brain injury. Pediatric Critical Care Medicine. 2012;13(1):85–91.
40.
Chong SL, Harjanto S, Testoni D, Ng ZM, Low CYD, Lee KP, et al. Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay. International Journal of Endocrinology. 2015;2015:1–8.
41.
Wong VS, Langley B. Epigenetic changes following traumatic brain injury and their implications for outcome, recovery and therapy. Neuroscience Letters. 2016;625:26–33.
42.
Ley EJ, Srour MK, Clond MA, Barnajian M, Tillou A, Mirocha J, et al. Diabetic Patients With Traumatic Brain Injury: Insulin Deficiency Is Associated With Increased Mortality. Journal of Trauma: Injury, Infection & Critical Care. 2011;70(5):1141–4.
43.
Kerby JD, Griffin RL, MacLennan P, Rue LW. Stress-Induced Hyperglycemia, Not Diabetic Hyperglycemia, Is Associated With Higher Mortality in Trauma. Annals of Surgery. 2012;256(3):446–52.
44.
Weaver LC, Bao F, Dekaban GA, Hryciw T, Shultz SR, Cain DP, et al. CD11d integrin blockade reduces the systemic inflammatory response syndrome after traumatic brain injury in rats. Experimental Neurology. 2015;271:409–22.
45.
Ruan H, Hacohen N, Golub TR, Van Parijs L, Lodish HF. Tumor Necrosis Factor-α Suppresses Adipocyte-Specific Genes and Activates Expression of Preadipocyte Genes in 3T3-L1 Adipocytes. Diabetes. 2002;51(5):1319–36.
46.
Gądek-Michalska A, Tadeusz J, Rachwalska P, Bugajski J. Cytokines, prostaglandins and nitric oxide in the regulation of stress-response systems. Pharmacological Reports. 2013;65(6):1655–62.
47.
Dufour S, Lebon V, Shulman GI, Petersen KF. Regulation of net hepatic glycogenolysis and gluconeogenesis by epinephrine in humans. American Journal of Physiology-Endocrinology and Metabolism. 2009;297(1):E231–5.
48.
Kulp GA, Herndon DN, Lee JO, Suman OE, Jeschke MG. EXTENT AND MAGNITUDE OF CATECHOLAMINE SURGE IN PEDIATRIC BURNED PATIENTS. Shock. 2010;33(4):369–74.
49.
Mizock BA. Alterations in fuel metabolism in critical illness: hyperglycaemia. Best Practice & Research Clinical Endocrinology & Metabolism. 2001;15(4):533–51.
50.
Srinivasan V. Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress! Journal of Diabetes Science and Technology. 2012;6(1):37–47.
51.
Liou DZ, Singer MB, Barmparas G, Harada MY, Mirocha J, Bukur M, et al. Insulin-dependent diabetes and serious trauma. European Journal of Trauma and Emergency Surgery. 2016;42(4):491–6.
52.
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.
53.
Bavisetty S, Bavisetty S, McArthur DL, Dusick JR, Wang C, Cohan P, et al. CHRONIC HYPOPITUITARISM AFTER TRAUMATIC BRAIN INJURY. Neurosurgery. 2008;62(5):1080–94.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.