Clinical significance of admission hyperglycemia and factors related to it in patients with acute severe head injury

BACKGROUND Patients in the acute stage after a severe head injury often exhibit systemic stress responses. The aim of the present study is to assess in such patients the clinical significance of the change of catecholamines (CA) and of blood glucose. METHODS The levels of serum of norepinephrine (NE), epinephrine (E), and dopamine (DA) were measured in 48 adults in the first 7 days after a severe head injury, and in 35 normal adults as a control group. The blood level of glucose at the time of admission was also measured. RESULTS It was found that: (1) The serum CA level was significantly higher in the injured group than in controls. (2) The serum NE and E levels were higher in patients with lower Glasgow Coma Scores (GCS) and in the group of patients who did not survive. (3) The blood glucose level on admission was related both to the serum NE and E levels within the first 24 hours after head injury (r = 0.574, p < 0.05 and r = 0.410 and p < 0.05, respectively) and also the GCS and Glasgow Outcome Score (GOS) in these patients. (4) Patients with GCS of 3-4, 5-6, and 7-8 had mean glucose levels on admission of 12.805 +/- 3.205 mmol/L (228 +/- 67.23 mg/100 mL), 9.133 +/- 1.228 mmol/L, (160 +/- 12.28 mg/100 mL) and 6.029 +/- 1.228 mmol/L (107.66 +/- 21.9 mg/100 mL), respectively (p < 0.01). (5) Ninety percent of the patients with blood glucose levels of 9.6 mmol/L (171.4 mg/100 mL) at admission died within the first month; in the patients with lower glucose levels the mortality was 15%. CONCLUSIONS These findings suggest that in the acute stage of severe head injury hyperglycemia and elevation of serum levels of CA are common components of the stress response, significant indicators of severity, and significant predictors of outcome.