Effect of early hyperglycemia on the mortality in pediatric patients with moderate to severe traumatic brain injury

Abstract:

Objective：To explore the effect of early hyperglycemia on the mortality in children with moderate to severe traumatic brain injury（TBI）. Methods：This retrospective cohort study was conducted in Department of Critical Care Medicine，Children’s Hospital of Chongqing Medical University between May 2012 and October 2014，including patients with moderate to severe TBI[admission Glas－gow Coma Scale（GCS）≤13]. The clinical data were collected. Multivariate logistic regression was used to identify risk factors related to mortality. Hyperglycemia was defined as glucose>200 mg/dL （11.1 mmol/L）. Unequal pupils and fixed pupils were defined as ab－normal pupil reflex. Results：Totally 109 patients with median age of 54 months [interquartile range（IQR） 17 to 82] were enrolled. There were 92 survivals and 17 deaths in hospital. The admission blood glucose of 21 patients was higher than 11.1 mmol/L. The glu－cose level，combined injury and abnormal pupil reflex ratio of death group were significantly higher than those of survival group [（14.31±6.46） vs. （7.08±3.38），76.5% vs. 47.5%，88.2% vs. 7.6%，P=0.000，P=0.010，P=0.000]. Admission GCS is lower in death group than in survival group （4 vs. 9，P=0.000）. Multivariate logistic regression analysis showed that admission hyperglycemia（OR=6.36，95%CI=1.20 to 33.68；P=0.029），abnormal pupil reflex（OR=17.09，95%CI=3.26 to 89.70；P=0.001） and admission GCS（OR=0.62，95%CI=0.39 to 1.00；P=0.048） were independent risk factors for death in children with moderate or severe TBI. However，com－bined injury（OR=1.20，95%CI=0.15 to 9.40；P=0.859） was not an independent risk factor for death in this study. Conclusion：The admission hyperglycemia is an independent risk factor for the prediction of death for moderate to severe TBI in Children.