scholarly journals Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1667
Author(s):  
Janett Kreutziger ◽  
Margot Fodor ◽  
Dagmar Morell-Hofert ◽  
Florian Primavesi ◽  
Stefan Stättner ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Liver Injury ◽  
Injury Severity ◽  
Severe Form ◽  
Liver Trauma ◽  
University Hospital ◽  
Hepatic Insulin Resistance ◽  
Trauma Patients ◽  
Stress Hyperglycemia ◽  
Glucose Levels

Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.

scholarly journals Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

2021 ◽  
Author(s):  
Janett Kreutziger ◽  
Margot Fodor ◽  
Dagmar Morell-Hofert ◽  
Florian Primavesi ◽  
Stefan Stättner ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Liver Injury ◽  
Injury Severity ◽  
Severe Form ◽  
Liver Trauma ◽  
University Hospital ◽  
Hepatic Insulin Resistance ◽  
Trauma Patients ◽  
Stress Hyperglycemia ◽  
Glucose Levels

Abstract Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage is known to trigger hepatic gluconeogenesis and glycogenolysis and also peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage.Methods: All patients with documented liver, kidney or spleen injuries, treated at a single, university hospital in Austria between 2000 and 2020 were charted in a register. Besides demographic, laboratory, radiological, surgical and other data were analyzed.Results: A total of 772 patients were included. In liver (n=456), spleen (n=375) and kidney (n=152) trauma, an increasing injury severity past moderate to severe (AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While this stress induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p<0.0001) and kidney injuries (median 10.6 mmol/L, p=0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p<0.0001). Conclusions: Absence of stress hyperglycemia is a sign of most severe liver injury (AAST V) and should prompt fundamental diagnostic and therapeutic procedures. Blood glucose should be considered as an additional diagnostic criterion in liver injury.

Is Blood Sugar the Next Lactate?

2006 ◽  
Vol 72 (7) ◽  
pp. 613-618 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Tracey Dechert ◽  
Nicholas Dalesio ◽  
Luke G. Wolfe ◽  
Nicholas Dalesio ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Injury Severity Score ◽  
Blood Glucose Level ◽  
Blood Sugar ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Infection Rates ◽  
Initial Blood

This study evaluates whether an initial blood glucose level is similarly predictive of injury severity and outcome as admission lactate in trauma patients. Between February 2004 and June 2005, we prospectively compared patients with presenting blood sugars of ≤150 mg/dL (LBS) with those with blood sugars >150 mg/dL (HBS). Fifty patients had BS above 150 mg/dL, whereas 176 patients were ≤150 mg/dL. These groups had similar demographics except for age. Injury Severity Score (ISS) of ≥15 was seen in 56.0 per cent of HBS patients versus 28.4 per cent of LBS patients (P = 0.0006). HBS patients had similar infection rates (12.0% HBS vs. 5.7% LBS, P = 0.13) but a higher mortality (30.0% HBS vs. 5.7% LBS, P < 0.0001). There was a linear relationship between ISS and BS (r2 = 0.18, P < 0.0001) and ISS and lactate (r2 = 0.17, P < 0.0001). Blood sugar trended with the lactate (r = 0.25, P = 0.0001). Hyperglycemic patients were more severely injured with higher mortality. BS correlated with lactate, and because it is easily obtainable, it may serve as a readily available predictor of injury severity and prognosis.

scholarly journals STUDY OF ALTERED GLUCOSE LEVELS IN CASES OF ACUTE ISCHEMIC STROKE AND ITS EFFECT ON PROGNOSIS

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Sunil I Mathew
Keyword(s):  
Blood Glucose ◽  
Medical Condition ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Stress Hyperglycemia ◽  
Exact Test ◽  
Glucose Levels ◽  
Altered Glucose ◽  
One Year ◽  
Glucose Estimation

IntroductionGlobally about 20 million people suffer from stroke each year. Stroke is a medical condition in which poor blood flow to the brain results in cell death. The risk factors causing stroke are high blood pressure, high blood, tobacco smoking, obesity cholesterol, diabetes mellitus and previous Transient Ischemic Attack (TIA).Objectives: To determine the association of stress hyperglycemia at admission with outcome of acute ischemic strokeMaterials and Methods: A study was done at Thiruvalla, Kerala for a period of one year. All new cases of cerebral infarction admitted comprised of 70 cases, 35 each in Euglycemia and Stress hyperglycemia group who were classified at the time of admission based on random blood glucose estimation with the features of stroke. All necessary investigations for the work-up of case required were done. Glasgow Outcome Score for the assessment of recovery in patients was scored, based on National Institute of Health Stroke Scale (NIHSS) on day 1, at the time of discharge and then again on day 30 to assess the clinical outcome. Standard descriptive statistics were used to report the data. Fisher's exact test and Students t test were used to compare the two groups. Binary logistic regression analysis was done.Result: Patients with stress hyperglycemia were found to have increased NIHSS scores on admission and this was more prominent at time of discharge on compared to euglycemic group. Poor recovery was associated with small and medium infarct size in stress hyperglycemia. However, prognosis worsened if size of infarct increased in both groups.Conclusion: Adequate control of blood glucose levels should be maintained immediately during admission and during follow-up to improve prognosis.Keywords: Stroke, Glucose levels, Prognosis

scholarly journals Surgical Outcomes in Patients with Simultaneous Traumatic Brain and Torso Injuries in a Single Regional Trauma Center over a 5-Year Period

2021 ◽  
Vol 34 (4) ◽  
pp. 270-278
Author(s):  
Jung-Ho Yun
Keyword(s):  
Surgical Treatment ◽  
Brain Injury ◽  
Abdominal Surgery ◽  
Trauma Center ◽  
Injury Severity ◽  
University Hospital ◽  
Brain Surgery ◽  
Secondary Brain Injury ◽  
Trauma Patients ◽  
Surgery First

Purpose: The purpose of the study is to analyze the results of surgical treatment of patients with brain and torso injury for 5 years in a single regional trauma center.Methods: We analyzed multiple trauma patients who underwent brain surgery and torso surgery for chest or abdominal injury simultaneously or sequentially among all 14,175 trauma patients who visited Dankook University Hospital Regional Trauma Center from January 2015 to December 2019.Results: A total of 25 patients underwent brain surgery and chest or abdominal surgery, with an average age of 55.4 years, 17 men and eight women. As a result of surgical treatment, there were 14 patients who underwent the surgery on the same day (resuscitative surgery), of which five patients underwent surgery simultaneously, four patients underwent brain surgery first, and one patient underwent chest surgery first, four patients underwent abdominal surgery first. Among the 25 treated patients, the 10 patients died, which the cause of death was five severe brain injuries and four hemorrhagic shocks.Conclusions: In multiple damaged patients require both torso surgery and head surgery, poor prognosis was associated with low initial Glasgow Coma Scale and high Injury Severity Score. On the other hand, patients had good prognosis when blood pressure was maintained and operation for traumatic brain injury was performed first. At the same time, patients who had operation on head and torso simultaneously had extremely low survival rates. This may be associated with secondary brain injury due to low perfusion pressure or continuous hypotension and the traumatic coagulopathy caused by massive bleeding.

scholarly journals Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care

2020 ◽  
Author(s):  
Alessandra Spasiano ◽  
Cristina Barbarino ◽  
Anna Marangone ◽  
Daniele Orso ◽  
Giulio Trillò ◽  
...  
Keyword(s):  
Injury Severity ◽  
Severe Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Acute Traumatic Coagulopathy ◽  
Comprehensive Overview ◽  
New Injury Severity Score ◽  
Trauma Population ◽  
Severity Of Injury ◽  
Almost All

Abstract Background Major brain injury and uncontrolled blood loss remain the primary causes of early trauma-related mortality. One-quarter to one-third of trauma patients exhibit trauma-induced coagulopathy (TIC). Thromboelastometry (ROTEM) and thrombelastography (TEG) are valuable alternatives to standard coagulation testing, providing a more comprehensive overview of the coagulation process. Purpose Evaluating thromboelastographic profile, the incidence of fibrinolysis (defined as Ly30 > 3%) in severe trauma patients, and factors influencing pathological coagulation pattern. Methods Prospective observational 2 years cohort study on severe trauma patients assisted by Helicopter Emergency Medical System (HEMS) and Level 1 Trauma Center, in a tertiary referral University Hospital. Results Eighty three patients were enrolled, mean NISS (new injury severity score) 36 (± 13). Mean R value decreased from 7.25 (± 2.6) to 6.19 (± 2.5) min (p < 0.03); 48 (60%) patients had a reduction in R from T0 to T1. In NISS 25–40 and NISS > 40 groups, changes in R value increased their significance (p = 0.04 and p < 0.03, respectively). Pathological TEG was found in 71 (88.8%) patients at T0 and 74 (92.5%) at T1. Hypercoagulation was present in 57 (71.3%) patients at T0, and in 66(82.5%) at T1. 9 (11.3%) patients had hyperfibrinolysis at T0, 7 (8.8%) patients at T1. Prevalence of StO2 < 75% at T0 was greater in patients whose TEG worsened (7 patients, 46.7%) against whose TEG remained stable or improved (8 patients, 17.4%) from T0 to T1 (p = 0.02). 48 (57.8%) patients received < 1000 mL of fluids, while 35 (42.2%) received ≥ 1000 mL. The first group had fewer patients with hypercoagulation (20, 41.6%) than the second (6, 17.6%) at T1 (p < 0.03). No differences were found for same TEG pattern at T0, nor other TEG pattern. Conclusion Our population is representative of a non-hemorrhagic severe injury subgroup. Almost all of our trauma population had coagulation abnormalities immediately after the trauma; pro-coagulant changes were the most represented regardless of the severity of injury. NISS appears to affect only R parameter on TEG. Hyperfibrinolysis has been found in a low percentage of patients. Hypoperfusion parameters do not help to identify patients with ongoing coagulation impairment. Small volume resuscitation and mild hypotermia does not affect coagulation, at least in the early post-traumatic phase.

scholarly journals Alcohol use in severely injured trauma patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Antti Riuttanen ◽  
Saara J. Jäntti ◽  
Ville M. Mattila
Keyword(s):  
Alcohol Use ◽  
Length Of Stay ◽  
Injury Severity ◽  
Relative Proportion ◽  
University Hospital ◽  
Trauma Patients ◽  
Severely Injured ◽  
New Injury Severity Score ◽  
Severity Scores ◽  
Medical Histories

Abstract Alcohol is a major risk factor for several types of injuries, and it is associated with almost all types and mechanisms of injury. The focus of the study was to evaluate alcohol use in severely injured trauma patients with New Injury Severity Score (NISS) of 16 or over, and to compare mortality, injury severity scores and mechanisms and patterns of injury between patients with positive and negative blood alcohol levels (BAL). Medical histories of all severely injured trauma patients (n = 347 patients) enrolled prospectively in Trauma Register of Tampere University Hospital (TAUH) between January 2016 to December 2017 were evaluated for alcohol/substance use, injury mechanism, mortality and length of stay in Intensive Care Unit (ICU). A total of 252 of 347 patients (72.6%) were tested for alcohol with either direct blood test (50.1%, 174/347), breathalyser (11.2%, 39/347), or both (11.2%, 39/347). After untested patients were excluded, 53.5% of adult patients (18–64 years), 20.5% of elderly patients (above 65 years) and 13.3% of paediatric patients (0–17 years) tested BAL positive. The mean measured BAL for the study population was 1.9 g/L. The incidence of injuries was elevated in the early evenings and the relative proportion of BAL positive patients was highest (67.7%) during the night. Injury severity scores (ISS or NISS) and length of stay in ICU were not adversely affected by alcohol use. Mortality was higher in patients with negative BAL (18.2% vs. 7.7%, p = 0.0019). Falls from stairs, and assaults were more common in patients with positive BAL (15.4% vs. 5.4% and 8.7% vs. 2.7%, p < 0.006, respectively). There were no notable differences in injury patterns between the two groups. Alcohol use among severely injured trauma patients is common. Injury mechanisms between patients with positive and negative BAL have differences, but alcohol use will not increase mortality or prolong length of stay in ICU. This study supports the previously reported findings that BAL is not a suitable marker to assess patient mortality in trauma setting.

Patterns and Effects of Admission Hyperglycemia And Inflammatory Response in Trauma Patients: A Prospective Study

2020 ◽  
Author(s):  
Ayman El-Menyar ◽  
Mohammad Asim ◽  
Fayaz Mir ◽  
Suhail Hakim ◽  
Ahad Kanbar ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Length Of Stay ◽  
Inflammatory Response ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Severity Of Injury ◽  
Hs Crp ◽  
Initial Blood

Abstract Background: Hyperglycemia following trauma could be a response to stress. The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center admissions. Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6 ,Il-18 and hs-CRP. Patients were categorized into 4 groups (non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)). The inflammatory markers were measured on 3 time points (admission, 24 h, and 48 h). Pearson’s correlation test and logistic regression analysis were performed. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (SIH&DH); of whom 50% had SIH. Compared to the other 3 groups; SIH patients were younger, had significantly higher ISS, higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p=0.005), lower Trauma Injury Severity Score (p=0.01) and lower GCS (p=0.001). IL-18 and hs-CRP were comparable among the study groups. Compared to the normoglycemia groups, patients with hyperglycemia had elevated high- sensitive troponin T (p=0.001) and required more blood transfusion (p=0.03). Patients with hyperglycemia had 3-times higher in-hospital mortality than the normoglycemia groups (p=0.02). A significant correlation was identified between initial blood glucose and serum lactate, IL-6, ISS and hospital length of stay. IL-6 correlated well with ISS (r=0.40, p=0.001). On- admission blood glucose had age-sex-GCS adjusted odd ratio 1.20(95% CI 1.06-1.33, p=0.003) for severe injury (ISS≥16).Conclusions: On-admission hyperglycemia is associated with a significant severer injury than normoglycemia patients. Initial blood glucose correlates with serum IL-6 which indicates a potential role of the systemic inflammatory response in the disease pathogenesis among the injured patients. On-admission glucose level could be a useful marker of injury severity, triage and risk assessment in trauma patients.This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016 https://clinicaltrials.gov/ct2/show/NCT02999386.

Injuries Associated with Pediatric Liver Trauma

2007 ◽  
Vol 73 (1) ◽  
pp. 37-41 ◽  
Author(s):  
John A. Deluca ◽  
Damian R. Maxwell ◽  
Sarah K. Flaherty ◽  
Jason M. Prigozen ◽  
Mary E. Scragg ◽  
...  
Keyword(s):  
Liver Injury ◽  
Injury Severity ◽  
Liver Trauma ◽  
Childhood Mortality ◽  
Associated Injuries ◽  
Injury Management ◽  
Pediatric Liver ◽  
Liver Injuries ◽  
Average Patient ◽  
High Index Of Suspicion

Injury remains the leading cause of childhood mortality for children younger than 14 years of age, with the liver being particularly susceptible to blunt trauma in children. This study reviews the authors’ institutions’ experience with pediatric liver injuries in an attempt to establish current patterns of injury, management and outcomes. A single-center, retrospective review was conducted of 105 consecutive pediatric patients who presented with a traumatic liver injury from January 1996 through February 2004. Average patient age was 13.1 ± 4.9 years and 58 per cent were male. Perihospital mortality was 8.6 per cent, with 67 per cent of mortality being attributed to head injury. The majority of patients were managed nonoperatively (81%). Liver injury was most often grade II (35%) by CT scan. Liver injury grade did not affect survival, but did affect injury management, with grade I and grade IV liver injuries more likely to be managed surgically ( P < 0.001). Grade I liver injuries were associated with concomitant spleen injuries, whereas grade IV injuries were associated with pancreatic injuries. Surgical management was associated with a higher injury severity score ( P = 0.005), higher mortality ( P = 0.01), and with other associated injuries as well. Children experiencing blunt abdominal trauma are at risk of significant morbidity and mortality; however, these risks stem more likely from associated injuries than injury to the liver proper. Clinicians should maintain a high index of suspicion for potentially catastrophic associated injuries to the pancreas with high-grade liver injury.

Hyperglycemia and Infections in Pediatric Trauma Patients

2008 ◽  
Vol 74 (3) ◽  
pp. 195-198 ◽  
Author(s):  
David W. Tuggle ◽  
M. Ann Kuhn ◽  
Susan K. Jones ◽  
Jennifer J. Garza ◽  
Sean Skinner
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Head Injuries ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Exact Test ◽  
Glucose Levels ◽  
Increased Risk ◽  
Level I

Hyperglycemia has been associated with poor outcome in children with head injuries and burns. However, there has not been a correlation noted between hyperglycemia and infections in severely injured children. The trauma registry of a Level I trauma center was queried for injured children <13 years admitted between July 1, 1999 and August 31, 2003. The records of severely injured children [Injury Severity Score (ISS) > 15] were examined for survival, age, weight, ISS, infection, length of stay (LOS), and maximum glucose levels within the first 24 hours of injury (D1G). Statistical analysis was performed using a t test, Fisher's exact test, a Mann-Whitney Rank Sum test, or Kendall's Tau where appropriate. Eight hundred and eighty eight children under 13 years of age were admitted. One hundred and nine had an ISS > 15, and 57 survived to discharge with measured D1G. Patients excluded were those who died in less than 72 hours or had an LOS less than 72 hours. The survivors were divided into high glucose (≥130 mg/dL; n = 48) and normal glucose (<130 mg/dL; n = 9). There was no difference between the groups with respect to age, weight, incidence of head injury, and ISS. An elevated D1G correlated with an increased risk of infection (P = 0.05) and an increased LOS (P = 0.01). These data suggest that severely injured children are often hyperglycemic in the first 24 hours after injury. Hyperglycemia in this study population correlated with an increased incidence of infection and increased length of stay. This suggests that strict control of hyperglycemia in injured children may be beneficial.

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