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Stress- Induced Hyperglycemia, not Diabetic Hyperglycemia, Leads to Worse Outcomes in Trauma
Jeffrey D Kerby*, Russell L. Griffin*, Paul MacLennan*, Loring W. Rue, III
University of Alabama at Birmingham, Birmingham, AL

Objectives: Stress-induced hyperglycemia (SIH) has previously been shown to result in worse outcomes after trauma. However, these studies were confounded by the presence of DM or occult DM within the cohort. We identified a pure population of patients with SIH to determine the true impact of SIH on outcomes after trauma. We also evaluated the ability of HbA1c levels to predict mortality compared to glucose levels.
Methods: Admission HbA1c, glucose levels, and comorbidity data were prospectively collected on trauma patients over a two year period. DM was determined by patient history or admission HbA1c > 6.5%. SIH was determined by absence of DM and admission glucose > 200 mg/dl. Cox proportional hazards models (adjusted for age and ISS) were used to calculate risk ratios (RRs) and associated 95% confidence intervals (CIs) for outcomes of interest. Additionally, ROC analysis was utilized to determine mortality predictions.
Results: During the study period 6,852 trauma patients were evaluated and 5,116 had available glucose, HbA1c and comorbidity data. Hyperglycemia was not associated with mortality or infectious complications among patients with DM. SIH lead to higher risk of pneumonia (aRR 1.47, CI 1.1-1.98) and mortality (aRR2.66, CI 1.99-3.56). Glucose was a better predictor of mortality than HbA1c (AUC 0.75 vs 0.61, respectively, p<0.0001).
Conclusions: As opposed to hyperglycemia associated with DM, SIH is predictive for worse outcomes after trauma. Likewise, glucose level was a better predictor of mortality than HbA1c alone. Further research is warranted to identify mechanisms causing SIH and subsequent worse outcomes following trauma.

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