Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

Author:

Matovu Paul1,Kirya Musa1,Galukande Moses1,Kiryabwire Joel2,Mukisa John3,Ocen William45,Lowery Wilson Michael6,Abio Anne7ORCID,Lule Herman78ORCID

Affiliation:

1. Department of General Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

2. Department of Neurosurgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda

3. Clinical Epidemiology Unit, Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda

4. Department of Surgery, Mulago Hospital Kampala, Kampala, Uganda

5. Department of Surgery, Lira University, Lira, Uganda

6. Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany

7. Turku Brain Injury Centre, Division of Clinical Neural Sciences, Turku University Hospital and University of Turku,, Injury Epidemiology and Prevention Research Group, Turku, Finland

8. Department of Surgery, Kampala International University Western Campus, Directorate of Research and Innovations, Kampala, Uganda

Abstract

Background Traumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda. Objective We aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda. Methods We consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without. Results Most patients (92.9%) were male aged 18–30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554]; P = 0.009) were significant predictors of mortality. Conclusion Hypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings.

Funder

Alexander von Humboldt-Stiftung, Bonn, Germany

Publisher

PeerJ

Subject

General Agricultural and Biological Sciences,General Biochemistry, Genetics and Molecular Biology,General Medicine,General Neuroscience

Reference38 articles.

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