Blood glucose concentrations in prehospital trauma patients with traumatic shock

Kreutziger, Janett; Lederer, Wolfgang; Schmid, Stefan; Ulmer, Hanno; Wenzel, Volker; Nijsten, Maarten W. N.; Werner, D.; Schlechtriemen, T.

doi:10.1097/eja.0000000000000733

Cited by 12 publications

(13 citation statements)

References 52 publications

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“…Over the last two decades, a vast number of publications have demonstrated the fundamental role of stress hyperglycemia in critical injury [1][2][3][4] and diverse critical conditions [21][22][23][24]. Up to date, there has been no consistency in de ning blood glucose levels, wherefore this trial resigns from specifying any threshold values for stress hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

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Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

Kreutziger

Fodor

Morell-Hofert

et al. 2021

Preprint

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Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage is known to trigger hepatic gluconeogenesis and glycogenolysis and also peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage.Methods: All patients with documented liver, kidney or spleen injuries, treated at a single, university hospital in Austria between 2000 and 2020 were charted in a register. Besides demographic, laboratory, radiological, surgical and other data were analyzed.Results: A total of 772 patients were included. In liver (n=456), spleen (n=375) and kidney (n=152) trauma, an increasing injury severity past moderate to severe (AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While this stress induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p<0.0001) and kidney injuries (median 10.6 mmol/L, p=0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p<0.0001). Conclusions: Absence of stress hyperglycemia is a sign of most severe liver injury (AAST V) and should prompt fundamental diagnostic and therapeutic procedures. Blood glucose should be considered as an additional diagnostic criterion in liver injury.

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Section: Discussionmentioning

confidence: 99%

“…Stress hyperglycemia is common in trauma patients and critical illness upon hospital admission and is often associated with worse outcome [1][2][3][4]. Hemorrhage aggravates this stress hyperglycemia signi cantly [5,6].…”

Section: Introductionmentioning

confidence: 99%

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

Kreutziger

Fodor

Morell-Hofert

et al. 2021

Preprint

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“…Theoretically, in some of the diabetic trauma patients hypoglycaemia may have been a consequence of anti-hyperglycaemic drug overdose from insulin or anti-diabetic drugs. In addition, hypoglycaemia in non-diabetic patients could have resulted from extensive shivering due to hypothermia, due to exposure to cold and wet environment, but also from chronic liver disease, intoxication, or severe liver and kidney trauma [ 22 , 23 , 45 – 48 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients – a retrospective Analysis

Kreutziger

Schmid

Umlauf

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundDeranged glucose metabolism is frequently observed in trauma patients after moderate to severe traumatic injury, but little data is available about pre-hospital blood glucose and its association with various cardiac rhythms and cardiac arrest following trauma.MethodsWe retrospectively investigated adult trauma patients treated by a nationwide helicopter emergency medical service (34 bases) between 2005 and 2013. All patients with recorded initial cardiac rhythms and blood glucose levels were enrolled. Blood glucose concentrations were categorised; descriptive and regression analyses were performed.ResultsIn total, 18,879 patients were included, of whom 185 (1.0%) patients died on scene. Patients with tachycardia (≥100/min, 7.0 ± 2.4 mmol/L p < 0.0001), pulseless ventricular tachycardia (9.8 ± 1.8, mmol/L, p = 0.008) and those with ventricular fibrillation (9.0 ± 3.2 mmol/L, p < 0.0001) had significantly higher blood glucose concentrations than did patients with normal sinus rhythm between 61 and 99/min (6.7 ± 2.1 mmol/L). In patients with low (≤2.8 mmol/L, 7/79; 8.9%, p < 0.0001) and high (> 10.0 mmol/L, 70/1271; 5.5%, p < 0.0001) blood glucose concentrations cardiac arrest was more common than in normoglycaemic patients (166/9433, 1.8%). ROSC was more frequently achieved in hyperglycaemic (> 10 mmol/L; 47/69; 68.1%) than in hypoglycaemic (≤4.2 mmol/L; 13/31; 41.9%) trauma patients (p = 0.01).ConclusionsIn adult trauma patients, pre-hospital higher blood glucose levels were related to tachycardic and shockable rhythms. Cardiac arrest was more frequently observed in hypoglycaemic and hyperglycaemic pre-hospital trauma patients. The rate of ROSC rose significantly with rising blood glucose concentration. Blood glucose measurements in addition to common vital parameters (GCS, heart rate, blood pressure, breathing frequency) may help identify patients at risk for cardiopulmonary arrest and dysrhythmias.

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“…Stress hyperglycemia is common in trauma patients, and critical illness on hospital admission and is often associated with poor outcome [1][2][3][4][5][6][7]. This stress hyperglycemia is caused by neuroendocrine, inflammatory and metabolic responses to trauma-associated stressors.…”

Section: Introductionmentioning

confidence: 99%

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

et al. 2021

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Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.

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Blood glucose concentrations in prehospital trauma patients with traumatic shock

Abstract: In adult trauma patients, low and high blood glucose concentrations were more common in patients with traumatic shock. Prehospital blood glucose concentration measurements in addition to common vital parameters may help identify patients at risk of traumatic shock.

Cited by 12 publications

References 52 publications

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients – a retrospective Analysis

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

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