Prognostic Value of Early Hyperglycemia in Neurocritically Ill Patients

Abstract

Objective To evaluate the relationship of early hyperglycemia and neurological prognosis in neurocritically ill patients. Methods This was a retrospective study of adult patients admitted to the neurosurgical intensive care unit (ICU) from January 2010 to July 2019. Primary outcome was neurological status at 6-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). Results A total of 202 patients were analyzed in this study. Of them, 70 (34.7%) patients had early hyperglycemia (≥200 mg/dL within 48 hours after ICU admission). Brain tumor (39.6%) and subarachnoid hemorrhage (17.8%) were the most common reasons for ICU admission. Ninety-three (46.0%) patients had favorable neurological outcomes (GOS of 4 or 5). Poor neurological outcome was more common in the early hyperglycemia group than in the non-hypoglycemia group (71.4% vs. 44.7%, p<0.001). In addition, 90-day mortality rate was significantly higher for patients with early hyperglycemia than that for patients without hyperglycemia (17.1% vs. 8.3%, p=0.011). Multivariable logistic regression analysis revealed that age (adjusted odd ratio [OR]: 1.04, 95% confidence interval (CI): 1.020-1.066), Acute Physiology and Chronic Health Evaluation II score on ICU admission (adjusted OR: 1.06, 95% CI: 1.003-1.113), and early hyperglycemia (adjusted OR: 2.32, 95% CI: 1.188-4.528) were significantly associated with poor neurological outcomes in neurocritically ill patients (Hosmer-Lemeshow Chi-squared = 5.43, df=8, p=0.711). Conclusions In this study, early hyperglycemia could be a significant predictor for neurological outcome in neurocritically ill patients.

Early metabolic derangements and unfavorable outcomes in pediatric traumatic brain injury: a retrospective multi-center cohort study

“…This leads to impaired aerobic glycolysis and intracellular acidosis that in turn cause a secondary toxic-ischemic effect on the brain (7). The association between these metabolic alterations and outcomes of pediatric TBI have been investigated in several single-center studies (2,5,8,9). These prior single-center studies have identified admission hyperglycemia as an important predictor of mortality in pediatric TBI (9)(10)(11)(12)(13)(14).…”