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Early predictive factors on mortality in head injured patients: a retrospective analysis of 112 traumatic brain injured patients.
MedLine Citation:
PMID:  22617175     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
AIM: Early hyperglycemia is a feature of traumatic brain injured (TBI) patients. The aim of our study was to analyze the impact of early hyperglycemia on in-ICU mortality in isolated TBI and its correlations with other factors responsible for secondary injury.
METHODS: We studied admission values (AV) and worse values in the first 48 hours (WV 48 h) of 112 ICU TBI patients (mortality 29.6%) of blood glucose (BG), base excess (BE), mean arterial pressure (MAP), PaO2/FiO2 ratio and serum hemoglobin (Hb). Predictive strength as the area under the receiver operating curves (AUROC) and correlation between all variables were calculated.
RESULTS: Data are expressed as median, 1st-3rd quartile. Both BG AV (147.5, 126-182 mg/dL; AUROC 0.716, P=0.0002) and WV 48 h (156.5, 132-192 mg/dL; AUROC 0.721, P=0.0001) are predictive of mortality. AV and WV 48 h are respectively: PaO2/FiO2 (366.8, 237.2-477.6 vs. 320, 214.4-426; P=0.05), MAP (90, 80-100.5 vs. 75, 66-83 mmHg; P<0.0001) and Hb (11.4, 9.7-13.1 vs. 10.6, 9-12.2 g/dL; P<0.02). BG AV and WV 48 h correlates with: age (r=0.419, P<0.0001 and r=0.489, P<0.0001), PaO2/FiO2 AV (r -0.223, P<0.03 and r -0.236, P<0.02), PaO2/FiO2 WV 48 h (r -0.215, P<0.03 and r -0.279, P<0.005) and MAP WV 48 h (r -0.216, P<0.03 and r -0.261, P<0.007).
CONCLUSION: Early hyperglycemia is a major predictor of mortality and correlates with other factors responsible for secondary injury. Early hyperglycemia seems to be a marker of inflammatory reaction responsible for early cardiovascular and respiratory impairment.
Authors:
L Prisco; F Iscra; M Ganau; G Berlot
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgical sciences     Volume:  56     ISSN:  0390-5616     ISO Abbreviation:  J Neurosurg Sci     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0432557     Medline TA:  J Neurosurg Sci     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  131-6     Citation Subset:  IM    
Affiliation:
Department of Perioperative Medicine, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Mista, Ospedali Riuniti di Trieste, Cattinara Hospital, Trieste, Italy - sisifo31@hotmail.com.
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