Severe
head injury is associated with a stress response that includes
hyperglycemia, which has been shown to worsen outcome before or during
cerebral ischemia. To better define the relationship between human
head injury and
hyperglycemia,
glucose levels were followed in 59 consecutive brain-injured patients from hospital admission up to 18 days after injury. The patients who had the highest peak admission 24-hour serum
glucose levels had the worse 18-day neurologic outcome (p = 0.01). Patients with peak 24-hour admission
glucose levels greater than 200 mg/dL had a two-unit increase in Glasgow Coma Scale score while patients with admission peak 24-hour serum
glucose levels less than or equal to 200 mg/dL had a four-unit increase in Glasgow Coma Scale score during the 18-day study period (p = 0.04). There was a significant relationship between 3-month and 1-year outcome and peak admission 24-hour serum
glucose level (p = 0.02 and p = 0.02, respectively). Those patients with admission peak 24-hour serum
glucose levels less than or equal to 200 mg/dL had a greater percentage of favorable outcome at 18 days, 3 months, and 1 year than those with admission peak 24-hour
glucose levels greater than 200 mg/dL (p = 0.0007, p = 0.03, and p = 0.005, respectively). A significant relationship between admission peak 24-hour Glasgow Coma Scale score and 18-day, 3-month, and 1-year outcomes was found (p = 0.0001, p = 0.0002, and p = 0.0002, respectively). Patients with mean admission peak 24-hour Glasgow Coma Scale scores of 3.5, 6, and 10 had mean admission 24-hour peak serum
glucose levels of 252 +/- 23.5, 219.1 +/- 19, and 185.8 +/- 21, respectively (p = 0.05). These relationships were not significantly altered when confounding variables such as the amount of
glucose given over the initial 24-hour postinjury period, the presence of diabetes or
multiple injuries, and whether patients were given
steroids,
dilantin, or
insulin were statistically incorporated. These data suggest that admission
hyperglycemia is a frequent component of the stress response to
head injury, a significant
indicator of severity of injury, and a significant predictor of outcome from
head injury.