|dc.description.abstract||The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among
trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and
inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and
cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.
Methods A prospective, observational study was conducted for adult trauma patients who were admitted and tested
for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized
into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stressinduced
hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and
48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory
markers. Pearson’s correlation test and logistic regression analysis were also performed.
Results During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with
hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury
Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had
lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS
(p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs
3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate,
IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39–33.68) points was found
more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical
significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40,
p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076–5.447, p = 0.03) for severe
injury (ISS[12) after adjusting for age, shock index and blood transfusion.
Conclusions In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is
associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for
patient triage and risk assessment.||en_US