Blood glucose and severe trauma

In recent years there has been increasing interest in the significance of the transitory raised blood glucose (hyperglycemia) that very often occurs in individuals suffering critical illness and trauma. A number of studies have shown an association between hyperglycemia and poor outcome. Knowledge in this area is extended by a recent retrospective study of patients suffering severe trauma. 

The aim of the study was to test the specific hypothesis that admission blood glucose is helpful in predicting outcome among victims of severe trauma. During a 2-year (2002-2004) study period, 555 of the 1675 patients admitted to the emergency room of the University Hospital of Berne, Switzerland had life-threatening injuries and thereby qualified for study entry. They were all adult and non-diabetic. 

The 555 patients were stratified according to admission blood glucose concentration to one of five groups: group 1 (n=35) blood glucose <5.56 mmol/L; group 2 (n=205) blood glucose 5.56-7.7 mmol/L; group 3 (n=173) blood glucose 7.5-10.0 mmol/L; group 4 (n=111) blood glucose 10.0-15.0 mmol/L; and finally group 5 (n=31) blood glucose >15.0 mmol/L. 

In total, 103 of the 555 died. Mortality was significantly higher in those with the highest blood glucose (groups 3-5). Less than 8 % of those in groups 1 and 2 died; this compared with 17 % in group 3, 38 % in group 4 and 74 % in group 5. 

In a separate regression analysis blood glucose was shown to be an independent predictor of hospital mortality when controlling for age, gender, injury severity and a range of laboratory data, including serum potassium, pH, bicarbonate, pCO₂, pO₂, lactate and prothrombin time. 

Inclusion of admission blood glucose was shown to significantly improve the accuracy of currently used models to predict mortality among trauma victims. The authors of the study were able to use the data generated to establish a model for prediction of death following severe trauma based on admission blood glucose alone.