Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 25;16(19):3562.
doi: 10.3390/ijerph16193562.

Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients

Wei-Ti Su  1 , Shao-Chun Wu  2 , Sheng-En Chou  3 , Chun-Ying Huang  4 , Shiun-Yuan Hsu  5 , Hang-Tsung Liu  6 , Ching-Hua Hsieh  7
Affiliations

Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients

Wei-Ti Su et al. Int J Environ Res Public Health. .

Abstract

Background: Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center.

Methods: Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes.

Results: DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, p < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, p < 0.001) and congestive heart failure (3.8% vs. 1.9%, p = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1-Q3], 20 [15-22] vs. 13 [10-18], p < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, p = 0.022, and 5.3% vs. 0.0%, p = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29-6.66; p = 0.690).

Conclusion: This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient's age, sex, comorbidities, and injury severity.

Keywords: admission hyperglycemia; diabetes mellitus; diabetic hyperglycemia; mortality; stress-induced hyperglycemia; thoracoabdominal trauma.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A flowchart in grouping the adult patients with thoracoabdominal injuries into the following subgroups: stress-induced hyperglycemia (SIH), diabetic hyperglycemia (DH), diabetic normoglycemia (DN), and nondiabetic normoglycemia (NDN). DM, diabetes mellitus.
See this image and copyright information in PMC

References

    1. Lecky B.O., Woodford M., Alexandrescu R., O’Brien S.J. Changing Epidemiology of Polytrauma. In: Pape H.C., Peitzman A.B., Rotondo M.F., Giannoudis P.V., editors. Damage Control Management in the Polytrauma Patient. Volume 3. Springer; New York, NY, USA: 2017. pp. 27–32.
    1. Demirhan R., Onan B., Oz K., Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: A 10-year experience. Interact. Cardiov. Th. 2009;9:450–453. doi: 10.1510/icvts.2009.206599. - DOI - PubMed
    1. Ioannidis O., Varnalidis I., Papapostolou D., Chatzopoulos S., Kotronis A., Paraskevas G., Konstantara A., Papadimitriou N., Makrantonakis A., Kakoutis E. Thoraco-abdominal injuries: The general surgeon’s perspective. Rev. Med. Chir. Soc. Med. Nat. Iasi. 2012;116:175–181. - PubMed
    1. Yang C.J., Liao W.I., Wang J.C., Tsai C.L., Lee J.T., Peng G.S., Lee C.H., Hsu C.W., Tsai S.H. Usefulness of glycated hemoglobin A1c-based adjusted glycemic variables in diabetic patients presenting with acute ischemic stroke. Am. J. Emerg. Med. 2017;35:1240–1246. doi: 10.1016/j.ajem.2017.03.049. - DOI - PubMed
    1. Figler B.D., Mack C.D., Kaufman R., Wessells H., Bulger E., Smith T.G., Voelzke B. Crash test rating and likelihood of major thoracoabdominal injury in motor vehicle crashes: the new car assessment program side-impact crash test, 1998-2010. J. Trauma Acute Care. 2014;76:750–754. doi: 10.1097/TA.0b013e3182aafd5b. - DOI - PMC - PubMed

MeSH terms