Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Tao Yuan, Hongyu He, Yuepeng Liu, Jianwei Wang, Xin Kang, Guanghui Fu, Fangfang Xie, Aimin Li, Jun Chen, Wenxue Wang, Tao Yuan, Hongyu He, Yuepeng Liu, Jianwei Wang, Xin Kang, Guanghui Fu, Fangfang Xie, Aimin Li, Jun Chen, Wenxue Wang

Abstract

Background: Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients.

Methods: This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS.

Results: A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43-9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43-9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months.

Conclusion: In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis.

Trial registration: ClinicalTrials.gov NCT02161055 . Registered on 11 June 2014.

Keywords: Blood glucose; Glasgow Outcome Score; Hyperglycemia; Insulin therapy; Traumatic brain injury.

Conflict of interest statement

The authors Tao Yuan, Hongyu He, Yuepeng Liu, Jianwei Wang, Xin Kang, Guanghui Fu, Fangfang Xie, Aimin Li, Jun Chen, and Wenxue Wang jointly declare that they have no conflicts of interest. All authors declared that the manuscript complies with all instructions to authors and that the final manuscript was approved by all authors. All authors confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
A A threshold, nonlinear association between the average blood glucose levels (mmol/L) and 6-month GOS was observed in a generalized additive model (GAM). The solid red line represents the smooth curve fit between variables. Blue bands represent the 95% confidence interval from the fit; 8.88 mmol/L (blood glucose level) were its inflection points (K). The 95% confidence interval of intervals of the infection points were 7.43 and 9.74. B A similar curve was found between the average blood glucose levels and 5-year GOS, in which 8.17 mmol/L was identified as the inflection point (K) with a 95% CI: 7.43–9.48. The same analysis revealed that there was also a bell relationship between average blood glucose levels and favorable outcome group (GOS ≥ 4) at 6 months C or 5 years D. The covariates were all adjusted for Glasgow coma score and Acute Physiology and Chronic Health Evaluation II score before surgery.

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Source: PubMed

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