Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population

Saadat, Seyed Mohammad Seyed; Bidabadi, Elham; Saadat, Sajjad; Mashouf, Mehryar; Salamat, Fatemeh; Yousefzadeh, Shahrokh

doi:10.1007/s00381-012-1753-5

Cited by 32 publications

(11 citation statements)

References 12 publications

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“…In this review, we have summarized the mechanisms leading to hyperglycemia after TBI, including stress response, inflammatory response, diabetes mellitus, pituitary and/or hypothalamic dysfunction, surgery, and anaesthesia. TBI patients with hyperglycemia possess an increased risk of poor outcome and an increased mortality rate, which is more pronounced with persistent hyperglycemia (PH) than hyperglycemia on admission [49]. Some of the direct effects of hyperglycemia may be attributed to lactic acidosis, electrolyte disturbances, inflammation, vessel disorders, rupture of the BBB, and hyperpermeability.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients who subsequently had an unfavorable outcome had higher glucose levels (>200 mg/dL or>11mmol/L) than did those with a better prognosis [11]. In addition, the relationship between high blood glucose levels and poor outcome after TBI appears to be more pronounced with persistent hyperglycemia (PH) than solely hyperglycemia on admission [49]. One study showed that PH was an independent predictor of clinical outcome in severe TBI, and PH was associated with higher mortality rates in patients with severe TBI [50].…”

Section: Hyperglycemia and Clinical Outcomes After Traumatic Brain Inmentioning

confidence: 99%

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Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor

et al. 2016

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Hyperglycemia after severe traumatic brain injury (TBI) occurs frequently and is associated with poor clinical outcome and increased mortality. In this review, we highlight the mechanisms that lead to hyperglycemia and discuss how they may contribute to poor outcomes in patients with severe TBI. Moreover, we systematically review the proper management of hyperglycemia after TBI, covering topics such as nutritional support, glucose control, moderated hypothermia, naloxone, and mannitol treatment. However, to date, an optimal and safe glycemic target range has not been determined, and may not be safe to implement among TBI patients. Therefore, there is a mandate to explore a reasonable glycemic target range that can facilitate recovery after severe TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Hyperglycemia and Clinical Outcomes After Traumatic Brain Inmentioning

confidence: 99%

Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor

et al. 2016

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“…Second, as indicated, we generally withhold glucose in the initial 48 hours after injury while closely monitoring blood glucose concentration [18]. In the survey referenced earlier [36], this approach is taken at ~ 30% of pediatric TBI centers likely given the long-recognized concerns in animal models and patients regarding hyperglycemia in the injured brain [43, 44]. However, we also recognize that the impact of withholding glucose on MEE in children with severe TBI remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

Energy Expenditure in Children After Severe Traumatic Brain Injury

Mtaweh

Smith

Kochanek

et al. 2014

Pediatric Critical Care Medicine

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Objective To evaluate energy expenditure in a cohort of children with severe traumatic brain injury (TBI). Design A prospective observational study. Setting A pediatric neurotrauma center within a tertiary care institution. Patients Mechanically-ventilated children admitted with severe traumatic brain injury (GCS<9) with a weight greater than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early, therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, anti-seizure prophylaxis and a tiered-based system for treating intracranial hypertension. Interventions Within the first week after injury, indirect calorimetry measurements were performed daily when the patient’s condition permitted. Measurements and Main Results Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure (MEE) obtained from indirect calorimetry was compared to resting energy expenditure (pREE) calculated from Harris-Benedict equation. Overall, MEE/pREE averaged 70.2 ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75 ± 4.5% vs. 68.9 ± 4.7% respectively, p = 0.273). Moreover, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4 ± 6% vs. 64.7 ± 4.7% for the unfavorable outcome, p = 0.13). Conclusions Contrary to previous work from several decades ago that suggested severe pediatric TBI is associated with a hypermetabolic response (MEE/pREE > 110%); our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe TBI is the first step in development of rational nutritional support goals that might lead to improvements in outcome.

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“…This is just like glucose control in TBI. Lots of studies determine that hyperglycemia is an independent risk factor for TBI [14], [15], [16], [17], [18], [19], but it does not mean that to reduce the glucose level will improve prognosis [20], [21], [22], [23]. Similarly, albumin supplement for patients of TBI is another problem researchers should investigate.…”

Section: Discussionmentioning

confidence: 99%

Serum Albumin and Prealbumin Predict the Poor Outcome of Traumatic Brain Injury

Bao

et al. 2014

PLoS ONE

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BackgroundSerum albumin and prealbumin are both negative acute-phase reactants, and usually at low levels in stress. We aim to determine their predictive values for poor outcome of traumatic brain injury (TBI).MethodsA total of 326 patients of TBI were enrolled and followed-up by telephone 6 months after discharge. They were divided into a favorable group (GOS: 3 to 5) and an unfavorable group (GOS: 1 to 2). Serum albumin and prealbumin were measured from vein blood within 24 h after admission.ResultsNinety one (27.9%) patients were with poor outcome (GOS: 1 to 2). The unfavorable group had lower albumin and prealbumin (P<0.001). Albumin and prealbumin were both positively correlated with GCS (r = 0.489, P<0.001; r = 0.222, P<0.001, respectively) and GOS (r = 0.518, P<0.001; r = 0.314, P<0.001, respectively). After adjustment for confounding factors, the odds ratios of albumin and prealbumin were 0.866, 95% CI: 0.829 to 0.904 and 0.990, 95% CI: 0.985 to 0.995, respectively. In subgroup of GCS≤8 (n = 101), the crude and adjusted odds ratios of serum albumin were both statistically significant (P = 0.027, P = 0.033, respectively), while prealbumin were not (P = 0.553, P = 0.576, respectively). The AUC of albumin for predicting poor outcome was 0.762, 95% CI: 0.712 to 0.807, which was significantly higher than that of prealbumin (0.664, 95% CI: 0.610 to 0.715). In analyses of all patients and subgroup of GCS≤8, the AUCs of serum albumin were both significantly higher than those of prealbumin (P = 0.001, P = 0.045, respectively).ConclusionsBoth serum albumin and prealbumin could predict the poor outcome of TBI, but the former is much better, especially, in patients with severe TBI.

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Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population

Abstract: Early hyperglycemia is associated with poor outcome, and persistent hyperglycemia is a powerful and independent predictor of mortality in children and adolescents with severe TBI.

Cited by 32 publications

References 12 publications

Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor

Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor

Energy Expenditure in Children After Severe Traumatic Brain Injury

Serum Albumin and Prealbumin Predict the Poor Outcome of Traumatic Brain Injury

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