Research Reports - Glucose variability negatively impacts long-term functional outcome in patients with traumatic brain injury

J Crit Care. 2012 Apr;27(2):125-31. Epub 2011 Oct 26.

Matsushima K, Peng M, Velasco C, Schaefer E, Diaz-Arrastia R, Frankel H.

PURPOSE: Significant glycemic excursions (so-called glucose variability) affect
the outcome of generic critically ill patients but has not been well studied in
patients with traumatic brain injury (TBI). The purpose of this study was to
evaluate the impact of glucose variability on long-term functional outcome of
patients with TBI.
MATERIAL AND METHODS: A noncomputerized tight glucose control protocol was used
in our intensivist model surgical intensive care unit. The relationship between
the glucose variability and long-term (a median of 6 months after injury)
functional outcome defined by extended Glasgow Outcome Scale (GOSE) was analyzed
using ordinal logistic regression models. Glucose variability was defined by SD
and percentage of excursion (POE) from the preset range glucose level.
RESULTS: A total of 109 patients with TBI under tight glucose control had
long-term GOSE evaluated. In univariable analysis, there was a significant
association between lower GOSE score and higher mean glucose, higher SD, POE more
than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL but not
POE 80 to 110. After adjusting for possible confounding variables in
multivariable ordinal logistic regression models, higher SD, POE more than 60,
POE 80 to 150, and single episode of glucose less than 60 mg/dL were
significantly associated with lower GOSE score.
CONCLUSIONS: Glucose variability was significantly associated with poorer
long-term functional outcome in patients with TBI as measured by the GOSE score.
Well-designed protocols to minimize glucose variability may be key in improving
long-term functional outcome.

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