Admission blood glucose as a predictor of shock and mortality in multiply injured patients

Winkelmann, Marcel; Butz, Ada Luise; Clausen, Jan-Dierk; Blossey, Richard David; Zeckey, Christian; Weber-Spickschen, Sanjay und Mommsen, Philipp (2019): Admission blood glucose as a predictor of shock and mortality in multiply injured patients. In: Sicot-J, Bd. 5, UNSP 17

Abstract

Introduction: Reliable diagnosis of shock in multiply injured patients is still challenging in emergency care. Point-of-care tests could have the potential to improve shock diagnosis. Therefore, this study aimed to analyze the impact of admission blood glucose on predicting shock in multiply injured patients. Methods: A retrospective cohort analysis of patients with an injury severity score (ISS) >= 16 who were treated in a level I trauma center from 01/2005 to 12/2014 was performed. Shock was defined by systolic blood pressure <= 90 mmHg and/or shock index >= 0.9 at admission. Laboratory shock parameters including glucose were measured simultaneously. Receiver-operating-characteristic (ROC) analysis and multivariate logistic regression analysis was performed. Results: Seven hundred and seventy-two patients were analyzed of whom 93 patients (12.0%) died. Two hundred and fifty-nine patients (33.5%) were in shock at admission. Mortality was increased if shock was present at admission (18.1% vs. 9.0%, p < 0.001). Mean glucose was 9.6 +/- 4.0 mmol/L if shock was present compared to 8.0 +/- 3.0 mmol/L (p < 0.001). Admission glucose positively correlated with shock (Spearman rho = 0.2, p < 0.001). Glucose showed an AUC of 0.62 (95% CI [0.58-0.66], p < 0.001) with an optimal cut off value of 11.5 mmol/L. Patients with admission glucose of > 11.5 mmol/L had a 2.2-fold risk of shock (95% CI [1.4-3.4], p = 0.001). Admission blood glucose of > 11.5 mmol/L positively correlated with mortality too (Spearman rho = 0.65, p < 0.001). Patients had a 2.5-fold risk of dying (95% CI [1.3-4.8], p = 0.004). Discussion: Admission blood glucose was proven as an independent indicator of shock and mortality and, therefore, might help to identify multiply injured patients at particular risk.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2426-8887
• Sprache: Englisch