hyperglycemia in severe traumatic brain injury patients and its association with 30 day mortality in mulago national hospital: a prospective cohort

Description

Background: Traumatic brain injury (TBI) is a growing public health concern which is associated with an acute stress response mediated by the sympathoadrenomedullary axis, this can be assessed by measuring blood glucose level. Hyperglycemia worsens underlying brain damage by causing free radical injury, apoptosis and tissue lactic acidosis. Hyperglycemia after severe traumatic brain injury (TBI) occurs frequently and is associated with increased mortality. Objective: To determine the prevalence of hyperglycemia in severe Traumatic brain injury patients and its association with 30day mortality in Mulago National Referral Hospital. Methods: The study design was a prospective cohort study. A total of 99 patients with severe TBI were recruited using consecutive sampling method. The serum glucose levels measured at admission and after 24hours. The study variables included; mechanism of injury, CT findings, location and size of hematoma, and social demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia to those without. Data were analysed using proportions or percentages for categorical variable and mean and standard deviation for continuous variable, for bivariate and multivariate analysis, Logistic regression was used. At bivariate, only variables with p-values ≤ 0.2 were considered for multivariate analysis. Odds ratio were used as measure of association. Findings of the study will form a basis for establishing management guidelines for Hyperglycemia in TBI. Findings; A total of 99 newly admitted patients with severe Traumatic brain injury in Mulago National Referral Hospital were enrolled in the study and followed up for one month. Most patients (35.5%) were between 18-30 years of age. Men accounted for the large part of the study (92.9%). Road Traffic Accidents were the most common cause of TBI (64.7%) followed by assault 17.1% and falls8.1%. Nearly 1in 6patients was admitted with hyperglycemia. The mortality rate in severe TBI patients as a result of admission hyperglycemia was 68.8% (O.R, 1.43; P=0.063) compared to 43.7% (N = 83) in those without hyperglycemia. Presence of convulsions was a significant predictor of mortality. (OR, 5. 64; P=0.009) Conclusions; Early Hyperglycemia following severe TBI does occur (16.7%) and there was no statistically significant association with mortality, but shows a tendency towards a high mortality rate (68.8%).