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01.12.2013 | Original Article

Reduced Brain/Serum Glucose Ratios Predict Cerebral Metabolic Distress and Mortality After Severe Brain Injury

verfasst von: Pedro Kurtz, Jan Claassen, J. Michael Schmidt, Raimund Helbok, Khalid A. Hanafy, Mary Presciutti, Hector Lantigua, E. Sander Connolly, Kiwon Lee, Neeraj Badjatia, Stephan A. Mayer

Erschienen in: Neurocritical Care | Ausgabe 3/2013

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Abstract

Background

The brain is dependent on glucose to meet its energy demands. We sought to evaluate the potential importance of impaired glucose transport by assessing the relationship between brain/serum glucose ratios, cerebral metabolic distress, and mortality after severe brain injury.

Methods

We studied 46 consecutive comatose patients with subarachnoid or intracerebral hemorrhage, traumatic brain injury, or cardiac arrest who underwent cerebral microdialysis and intracranial pressure monitoring. Continuous insulin infusion was used to maintain target serum glucose levels of 80–120 mg/dL (4.4–6.7 mmol/L). General linear models of logistic function utilizing generalized estimating equations were used to relate predictors of cerebral metabolic distress (defined as a lactate/pyruvate ratio [LPR] ≥ 40) and mortality.

Results

A total of 5,187 neuromonitoring hours over 300 days were analyzed. Mean serum glucose was 133 mg/dL (7.4 mmol/L). The median brain/serum glucose ratio, calculated hourly, was substantially lower (0.12) than the expected normal ratio of 0.40 (brain 2.0 and serum 5.0 mmol/L). In addition to low cerebral perfusion pressure (P = 0.05) and baseline Glasgow Coma Scale score (P < 0.0001), brain/serum glucose ratios below the median of 0.12 were independently associated with an increased risk of metabolic distress (adjusted OR = 1.4 [1.2–1.7], P < 0.001). Low brain/serum glucose ratios were also independently associated with in-hospital mortality (adjusted OR = 6.7 [1.2–38.9], P < 0.03) in addition to Glasgow Coma Scale scores (P = 0.029).

Conclusions

Reduced brain/serum glucose ratios, consistent with impaired glucose transport across the blood brain barrier, are associated with cerebral metabolic distress and increased mortality after severe brain injury.

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Titel: Reduced Brain/Serum Glucose Ratios Predict Cerebral Metabolic Distress and Mortality After Severe Brain Injury
verfasst von: Pedro Kurtz
Jan Claassen
J. Michael Schmidt
Raimund Helbok
Khalid A. Hanafy
Mary Presciutti
Hector Lantigua
E. Sander Connolly
Kiwon Lee
Neeraj Badjatia
Stephan A. Mayer
Publikationsdatum: 01.12.2013
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 3/2013
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-013-9919-x

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