Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PeerJ
Abstract
Traumatic brain injury (TBI) is a growing public health concern that
can be complicated with an acute stress response. This response may be assessed
by monitoring blood glucose levels but this is not routine in remote settings. There is
a paucity of data on the prevalence of hyperglycemia and variables associated with
mortality after severe TBI in Uganda.
Objective: We aimed to determine the prevalence of hyperglycemia in patients with
severe TBI and variables associated with 30-day mortality at Mulago National
Referral Hospital in Uganda.
Methods: We consecutively enrolled a cohort 99 patients patients with severe
TBI. Serum glucose levels were measured at admission and after 24 h. Other study
variables included: mechanism of injury, CT findings, location and size of hematoma,
and socio-demographics. The main outcome was mortality after 30 days of
management and this was compared in patients with hyperglycemia more than
11.1 mmol/L to those without.
Results: Most patients (92.9%) were male aged 18–30 years (47%). Road Traffic
Collisions were the most common cause of severe TBI (64.7%) followed by
assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with
hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients
with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against
43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95%
CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554];
P = 0.009) were significant predictors of mortality. Conclusion: Hypothermia and convulsions at admission were major predictors of
mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur
with a tendency towards high mortality. These findings justify routine glucose
monitoring and could form the basis for establishing a blood sugar control protocol
for such patients in remote settings.
Description
Keywords
Traumatic-brain-injury, Hyperglycemia, Prevalence, Mortality
Citation
Matovu P, Kirya M, Galukande M, Kiryabwire J, Mukisa J, Ocen W, Lowery Wilson M, Abio A, Lule H. 2021. Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda. PeerJ 9:e10589 DOI 10.7717/peerj.10589