The relationship between HbA1C levels and clinical outcome in patients with traumatic brain injury: A prospective study
HbA1C and clinical outcome in patients with TBI
Sažetak
Recently, Hemoglobin A1C (HbA1C) level has been suggested as a predictor of mortality and poor clinical outcomes in patients with trauma. The aim of this study was to evaluation of the relationship between HbA1C levels and clinical outcome in patients with traumatic brain injury (TBI).
In a cross-sectional study, 133 TBI patients referred to the emergency department of Imam Khomeini Hospital in Mazandaran, Iran. Eligible patients were examined by a neurosurgeon at the time of admission to the emergency department and their GCS were recorded. After transferring the patients to the neurosurgery ward, their HbA1C, fasting blood sugar (FBS) level and postprandial plasma glucose at 2 hours (BS2hpp) were measured. Also, patients' GCS were recorded at 24 hours after admission and at the time of discharge from the hospital.
The mean and standard deviation of GCS score of patients at the time of admission, 24 hours after admission, and at the time of discharge were 9.02 (2.09), 10.07 (2.16), and 12.98 (1.82), respectively. Patients' mean HbA1C, BS2hpp, and FBS levels were 5.59% (0.75), 174.56 mg/dL (51.74), and 114.67 mg/dL (26.04), respectively. The mean GCS of patients with HbA1C<5.7% was significantly lower than patients with HbA1C=5.7-6.5%, at the time of admission (P<0.05). At 24 hours after admission, the mean GCS of patients with HbA1C<5.7% was significantly lower than the other groups (P<0.05).
According to the results of this study it seems that HbA1C measurements cannot provide clear information about the clinical outcome of patients with TBI.
Reference
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5. Fann JR, Ribe AR, Pedersen HS, Fenger-Grøn M, Christensen J, Benros ME, et al. Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study. Lancet Psychiatry. 2018;5(5):424-31. https://doi.org/10.1016/S2215-0366(18)30065-8.
6. Kenney K, Diaz-Arrastia R. Risk of Dementia Outcomes Associated With Traumatic Brain Injury During Military Service. JAMA Neurol. 2018;75(9):1043-44. https://doi.org/10.1001/jamaneurol.2018.0347.
7. Sugarman MA, McKee AC, Stein TD, Tripodis Y, Besser LM, Martin B, et al. Failure to detect an association between self-reported traumatic brain injury and Alzheimer's disease neuropathology and dementia. Alzheimers Dement. 2019;15(5):686-98. https://doi.org/10.1016/j.jalz.2018.12.015.
8. Fu TS, Jing R, Fu WW, Cusimano MD. Epidemiological Trends of Traumatic Brain Injury Identified in the Emergency Department in a Publicly-Insured Population, 2002-2010. PloS One. 2016;11(1):e0145469. https://doi.org/10.1371/journal.pone.0145469.
9. Kaimal G, Walker MS, Herres J, French LM, DeGraba TJ. Observational study of associations between visual imagery and measures of depression, anxiety and post-traumatic stress among active-duty military service members with traumatic brain injury at the Walter Reed National Military Medical Center. BMJ Open. 2018;8(6):e021448. https://doi.org/10.1136/bmjopen-2017-021448.
10. Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, et al. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry. 2019;76(3):249-58. https://doi.org/10.1001/jamapsychiatry.2018.4288.
11. Liu C, Xie J, Xiao X, Li T, Li H, Bai X, et al. Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma. Int J Med Sci. 2021;18(7):1639-1647. https://doi.org/10.7150/ijms.54913.
12. Majdan M, Brazinova A, Rusnak M, Leitgeb J. Outcome prediction after traumatic brain injury: comparison of the performance of routinely used severity scores and multivariable prognostic models. J Neurosci Rural Pract. 2017;8(1):20-29. https://doi.org/10.4103/0976-3147.193543.
13. Matovu P, Kirya M, Galukande M, Kiryabwire J, Mukisa J, Ocen W, et al. Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda. PeerJ. 2021;9:e10589. https://doi.org/10.7717/peerj.10589.
14. Terzioglu B, Ekinci O, Berkman Z. Hyperglycemia is a predictor of prognosis in traumatic brain injury: Tertiary intensive care unit study. J Res Med Sci. 2015;20(12):1166. https://doi.org/10.4103/1735-1995.172984.
15. Shi J, Dong B, Mao Y, Guan W, Cao J, Zhu R, et al. Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget. 2016;7(43):71052. https://doi.org/10.18632/oncotarget.11958.
16. Bosarge PL, Shoultz TH, Griffin RL, Kerby JD. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury. J Trauma Acute Care Surg. 2015; 79(2):289-94. https://doi.org/10.1097/TA.0000000000000716.
17. Kafaki SB, Alaedini K, Qorbani A, Asadian L, Haddadi K. Hyperglycemia: a predictor of death in severe head injury patients. Clin Med Insights Endocrinol Diabetes. 2016;9:43-46. https://doi.org/10.4137/CMED.S40330.
18. Jeremitsky E, Omert LA, Dunham CM, Wilberger J, Rodriguez A. The Impact of Hyperglycemia on Patients With Severe Brain Injury. J Trauma Acute Care Surg. 2005;58(1):47-50. https://doi.org/10.1097/01.ta.0000135158.42242.b1.
19. Wettervik TS, Howells T, Ronne-Engström E, Hillered L, Lewén A, Enblad P, et al. High arterial glucose is associated with poor pressure autoregulation, high cerebral lactate/pyruvate ratio and poor outcome following traumatic brain injury. Neurocrit Care. 2019;31(3):526-533. https://doi.org/10.1007/s12028-019-00743-2.
20. Hermanides J, Plummer MP, Finnis M, Deane AM, Coles JP, Menon DK. Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis. Crit Care. 2018;22(1):11. https://doi.org/10.1186/s13054-017-1883-y.
21. Guo F, Shen H. Glycosylated hemoglobin as a predictor of sepsis and all-cause mortality in trauma patients. Infect Drug Resist. 2021;14:2517-2526. https://doi.org/10.2147/IDR.S307868.
22. Dandapat S, Siddiqui FM, Fonarow GC, Bhatt DL, Xu H, Matsouaka R, et al. A paradoxical relationship between hemoglobin A1C and in-hospital mortality in intracerebral hemorrhage patients. Heliyon. 2019;5(5):e01659. https://doi.org/10.1016/j.heliyon.2019.e01659.
23. Jiang Z, Wang J, Zhao P, Zhang L, Guo Y. HbA1c: High in acute cerebral infarction and low in brain trauma. Prog Mol Biol Transl Sci. 2019;162:293-306. https://doi.org/10.1016/bs.pmbts.2019.01.008.
24. Cappa KA, Conger JC, Conger AJ. Injury severity and outcome: A meta-analysis of prospective studies on TBI outcome. Health Psychol. 2011; 30(5):542-60. https://doi.org/10.1037/a0025220.
25. Hidayatulloh S, Widodo D, Seweng A. Dynamics of Serum Lactate and Glucose Level with Coagulation Factors in Moderate and Severe Traumatic Brain Injury. Int J Surg Med. 2020;6(1):37-41.
26. Kutter D, Thoma J. Hereditary spherocytosis and other hemolytic anomalies distort diabetic control by glycated hemoglobin. Clin Lab. 2006;52(9-10):477-81.
27. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab. 2008; 93(7):2447-53. https://doi.org/10.1210/jc.2007-2174.
28. Bao Y, Gu D. Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis. Front Neurol. 2021;12:642899. https://doi.org/10.3389/fneur.2021.642899.
29. Lionel KR, John J, Sen N. Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit. Indian J Crit Care Med. 2014;18(1):21-5. https://doi.org/10.4103/0972-5229.125431.
30. Jalloh I, Carpenter KL, Helmy A, Carpenter TA, Menon DK, Hutchinson PJ. Glucose metabolism following human traumatic brain injury: methods of assessment and pathophysiological findings. Metab Brain Dis. 2015 Jun;30(3):615-32. https://doi.org/10.1007/s11011-014-9628-y.
31. Gale SC, Crnp CS, Reilly PM, Schwab CW, Gracias VH. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg. 2007;73(5):454-60. https://doi.org/10.1177/000313480707300507.
32. Kreutziger J, Schlaepfer J, Wenzel V, Constantinescu MA. The role of admission blood glucose in outcome prediction of surviving patients with multiple injuries. J Trauma. 2009;67(4):704-8. https://doi.org/10.1097/TA.0b013e3181b22e37.
33. Salim A, Hadjizacharia P, Dubose J, Brown C, Inaba K, Chan LS, et al. Persistent hyperglycemia in severe traumatic brain injury: an independent predictor of outcome. Am Surg. 2009;75(1):25-9.
34. Saadat SMS, Bidabadi E, Saadat SNS, Mashouf M, Salamat F, Yousefzadeh S. Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population. Childs Nerv Syst. 2012;28(10):1773-7. https://doi.org/10.1007/s00381-012-1753-5.
35. Mastrototaro JJ. The MiniMed continuous glucose monitoring system. Diabetes Technol Ther. 2000;2(1, Supplement 1):13-8.
36. Yuan Q, Liu H, Xu Y, Wu X, Sun Y, Hu J. Continuous measurement of the cumulative amplitude and duration of hyperglycemia best predicts outcome after traumatic brain injury. Neurocrit Care. 2014;20(1):69-76. https://doi.org/10.1007/s12028-012-9730-0.
37. Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, et al. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diabetes Care. 2007;30(10):2453-7. https://doi.org/10.2337/dc06-2003.
2. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987-1048. https://doi.org/10.1016/S1474-4422(17)30371-X.
3. Crane PK, Gibbons LE, Dams-O'Connor K, Trittschuh E, Leverenz JB, Keene CD, et al. Association of Traumatic Brain Injury With Late-Life Neurodegenerative Conditions and Neuropathologic Findings. JAMA Neurol. 2016;73(9):1062-9. https://doi.org/10.1001/jamaneurol.2016.1948.
4. Barnes DE, Byers AL, Gardner RC, Seal KH, Boscardin WJ, Yaffe K. Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans. JAMA Neurol. 2018;75(9):1055-61. https://doi.org/10.1001/jamaneurol.2018.0815.
5. Fann JR, Ribe AR, Pedersen HS, Fenger-Grøn M, Christensen J, Benros ME, et al. Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study. Lancet Psychiatry. 2018;5(5):424-31. https://doi.org/10.1016/S2215-0366(18)30065-8.
6. Kenney K, Diaz-Arrastia R. Risk of Dementia Outcomes Associated With Traumatic Brain Injury During Military Service. JAMA Neurol. 2018;75(9):1043-44. https://doi.org/10.1001/jamaneurol.2018.0347.
7. Sugarman MA, McKee AC, Stein TD, Tripodis Y, Besser LM, Martin B, et al. Failure to detect an association between self-reported traumatic brain injury and Alzheimer's disease neuropathology and dementia. Alzheimers Dement. 2019;15(5):686-98. https://doi.org/10.1016/j.jalz.2018.12.015.
8. Fu TS, Jing R, Fu WW, Cusimano MD. Epidemiological Trends of Traumatic Brain Injury Identified in the Emergency Department in a Publicly-Insured Population, 2002-2010. PloS One. 2016;11(1):e0145469. https://doi.org/10.1371/journal.pone.0145469.
9. Kaimal G, Walker MS, Herres J, French LM, DeGraba TJ. Observational study of associations between visual imagery and measures of depression, anxiety and post-traumatic stress among active-duty military service members with traumatic brain injury at the Walter Reed National Military Medical Center. BMJ Open. 2018;8(6):e021448. https://doi.org/10.1136/bmjopen-2017-021448.
10. Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, et al. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry. 2019;76(3):249-58. https://doi.org/10.1001/jamapsychiatry.2018.4288.
11. Liu C, Xie J, Xiao X, Li T, Li H, Bai X, et al. Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma. Int J Med Sci. 2021;18(7):1639-1647. https://doi.org/10.7150/ijms.54913.
12. Majdan M, Brazinova A, Rusnak M, Leitgeb J. Outcome prediction after traumatic brain injury: comparison of the performance of routinely used severity scores and multivariable prognostic models. J Neurosci Rural Pract. 2017;8(1):20-29. https://doi.org/10.4103/0976-3147.193543.
13. Matovu P, Kirya M, Galukande M, Kiryabwire J, Mukisa J, Ocen W, et al. Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda. PeerJ. 2021;9:e10589. https://doi.org/10.7717/peerj.10589.
14. Terzioglu B, Ekinci O, Berkman Z. Hyperglycemia is a predictor of prognosis in traumatic brain injury: Tertiary intensive care unit study. J Res Med Sci. 2015;20(12):1166. https://doi.org/10.4103/1735-1995.172984.
15. Shi J, Dong B, Mao Y, Guan W, Cao J, Zhu R, et al. Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget. 2016;7(43):71052. https://doi.org/10.18632/oncotarget.11958.
16. Bosarge PL, Shoultz TH, Griffin RL, Kerby JD. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury. J Trauma Acute Care Surg. 2015; 79(2):289-94. https://doi.org/10.1097/TA.0000000000000716.
17. Kafaki SB, Alaedini K, Qorbani A, Asadian L, Haddadi K. Hyperglycemia: a predictor of death in severe head injury patients. Clin Med Insights Endocrinol Diabetes. 2016;9:43-46. https://doi.org/10.4137/CMED.S40330.
18. Jeremitsky E, Omert LA, Dunham CM, Wilberger J, Rodriguez A. The Impact of Hyperglycemia on Patients With Severe Brain Injury. J Trauma Acute Care Surg. 2005;58(1):47-50. https://doi.org/10.1097/01.ta.0000135158.42242.b1.
19. Wettervik TS, Howells T, Ronne-Engström E, Hillered L, Lewén A, Enblad P, et al. High arterial glucose is associated with poor pressure autoregulation, high cerebral lactate/pyruvate ratio and poor outcome following traumatic brain injury. Neurocrit Care. 2019;31(3):526-533. https://doi.org/10.1007/s12028-019-00743-2.
20. Hermanides J, Plummer MP, Finnis M, Deane AM, Coles JP, Menon DK. Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis. Crit Care. 2018;22(1):11. https://doi.org/10.1186/s13054-017-1883-y.
21. Guo F, Shen H. Glycosylated hemoglobin as a predictor of sepsis and all-cause mortality in trauma patients. Infect Drug Resist. 2021;14:2517-2526. https://doi.org/10.2147/IDR.S307868.
22. Dandapat S, Siddiqui FM, Fonarow GC, Bhatt DL, Xu H, Matsouaka R, et al. A paradoxical relationship between hemoglobin A1C and in-hospital mortality in intracerebral hemorrhage patients. Heliyon. 2019;5(5):e01659. https://doi.org/10.1016/j.heliyon.2019.e01659.
23. Jiang Z, Wang J, Zhao P, Zhang L, Guo Y. HbA1c: High in acute cerebral infarction and low in brain trauma. Prog Mol Biol Transl Sci. 2019;162:293-306. https://doi.org/10.1016/bs.pmbts.2019.01.008.
24. Cappa KA, Conger JC, Conger AJ. Injury severity and outcome: A meta-analysis of prospective studies on TBI outcome. Health Psychol. 2011; 30(5):542-60. https://doi.org/10.1037/a0025220.
25. Hidayatulloh S, Widodo D, Seweng A. Dynamics of Serum Lactate and Glucose Level with Coagulation Factors in Moderate and Severe Traumatic Brain Injury. Int J Surg Med. 2020;6(1):37-41.
26. Kutter D, Thoma J. Hereditary spherocytosis and other hemolytic anomalies distort diabetic control by glycated hemoglobin. Clin Lab. 2006;52(9-10):477-81.
27. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab. 2008; 93(7):2447-53. https://doi.org/10.1210/jc.2007-2174.
28. Bao Y, Gu D. Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis. Front Neurol. 2021;12:642899. https://doi.org/10.3389/fneur.2021.642899.
29. Lionel KR, John J, Sen N. Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit. Indian J Crit Care Med. 2014;18(1):21-5. https://doi.org/10.4103/0972-5229.125431.
30. Jalloh I, Carpenter KL, Helmy A, Carpenter TA, Menon DK, Hutchinson PJ. Glucose metabolism following human traumatic brain injury: methods of assessment and pathophysiological findings. Metab Brain Dis. 2015 Jun;30(3):615-32. https://doi.org/10.1007/s11011-014-9628-y.
31. Gale SC, Crnp CS, Reilly PM, Schwab CW, Gracias VH. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg. 2007;73(5):454-60. https://doi.org/10.1177/000313480707300507.
32. Kreutziger J, Schlaepfer J, Wenzel V, Constantinescu MA. The role of admission blood glucose in outcome prediction of surviving patients with multiple injuries. J Trauma. 2009;67(4):704-8. https://doi.org/10.1097/TA.0b013e3181b22e37.
33. Salim A, Hadjizacharia P, Dubose J, Brown C, Inaba K, Chan LS, et al. Persistent hyperglycemia in severe traumatic brain injury: an independent predictor of outcome. Am Surg. 2009;75(1):25-9.
34. Saadat SMS, Bidabadi E, Saadat SNS, Mashouf M, Salamat F, Yousefzadeh S. Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population. Childs Nerv Syst. 2012;28(10):1773-7. https://doi.org/10.1007/s00381-012-1753-5.
35. Mastrototaro JJ. The MiniMed continuous glucose monitoring system. Diabetes Technol Ther. 2000;2(1, Supplement 1):13-8.
36. Yuan Q, Liu H, Xu Y, Wu X, Sun Y, Hu J. Continuous measurement of the cumulative amplitude and duration of hyperglycemia best predicts outcome after traumatic brain injury. Neurocrit Care. 2014;20(1):69-76. https://doi.org/10.1007/s12028-012-9730-0.
37. Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, et al. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diabetes Care. 2007;30(10):2453-7. https://doi.org/10.2337/dc06-2003.
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2025/12/21
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Originalni rad / Original article