Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury
Abstract Purpose The study aimed to investigate the association between blood glucose or lactate and the outcomes of severe traumatic brain injury (TBI), and to evaluate the effect of mild hypothermia therapy on glucose and lactate levels. Methods Eighty-one patients with TBI were randomly divided i...
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| Veröffentlicht in: | Journal of critical care 2011-06, Vol.26 (3), p.311-315 |
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| creator | Zhao, Qing-Jv, MD Zhang, Xue-Guang, MD Wang, Le-Xin, MD, PhD |
| description | Abstract Purpose The study aimed to investigate the association between blood glucose or lactate and the outcomes of severe traumatic brain injury (TBI), and to evaluate the effect of mild hypothermia therapy on glucose and lactate levels. Methods Eighty-one patients with TBI were randomly divided into normothermia (n = 41) and mild hypothermia (n = 40) group. Body temperature of hypothermia group was maintained at 32.7°C for 72 hours. Arterial blood glucose and lactic acid were determined before and after hypothermia therapy. Glasgow Outcome Scale (GOS) score was assessed 3 months after the treatment. Results The mean glucose (7.04 ± 0.51 vs 9.71 ± 1.63 mmol/L, P < .05) in the hypothermia group was lower than in the normothermia group after hypothermia therapy. There were more patients with good neurologic function (GOS 4-5) in the hypothermia group than in the normothermia group (75.0% vs 51.2%, P = .038). Multivariate regression analysis showed that blood glucose greater than 10 mmol/L (adjusted risk ratio, 5.7; 95% confidence interval, 1.4-13.2; P < .05) was an independent predictor for poor neurologic outcomes in these patients, and hypothermia therapy was an independent predictor for favorable outcomes (risk ratio, 4.9; 95% confidence interval, 1.0-15.6; P < .05). No significant association between lactate and GOS scores was identified in the multivariate analysis. Conclusion Hyperglycemia after TBI was associated with poor clinical outcomes, but the predictive value of blood lactate level requires further investigation. Hypothermia therapy improves neurologic outcomes in patients with severe TBI, and reduction in blood glucose may be partially responsible for the improved outcomes. |
| doi_str_mv | 10.1016/j.jcrc.2010.08.014 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_868995907</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0883944110002418</els_id><sourcerecordid>868995907</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-8b517c68b24ba41533cdf92183b0a6cbe7e2ab7baacdd69af7882091a5f48fb3</originalsourceid><addsrcrecordid>eNp9kkuLFEEMxwtR3HH1C3iQAg-eeqxHP6pBBFl8wYoH917UI71TbXfXWI-R_gp-aquZVWEPnhKSX0KSfxB6TsmeEtq-HvejCWbPSAkQsSe0foB2tGm6SrS0eYh2RAhe9XVNL9CTGEdCaMd58xhdsJLpmeh26NcXN1l8WI8-HSDMTuHNquOKA9hsIGI9eW_x7ZSNj4DVYvGkTFLp7Lv5GPypYAvk4Cd_6wz2ORk_l5hb8FElB0uK-KdLBxzhBAFwCirPJWGwDqpAbhlzWJ-iR4OaIjy7s5fo5sP7m6tP1fXXj5-v3l1XpuYiVUI3tDOt0KzWqqYN58YOPaOCa6Jao6EDpnSnlTLWtr0aOiEY6alqhloMml-iV-e2ZfAfGWKSs4sGpkkt4HOUohV93_SkK-TLe-Toc1jKbJISzllN26YtFDtTJvgYAwzyGNyswloguekkR7npJDedJBGy6FSKXty1znoG-7fkjzAFeHMGoFzi5CDIaMohDVgXwCRpvft__7f3ys3kFmfU9B1WiP_2kJFJIr9tn7I9CiWElL0E_w0KcbxY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1033241656</pqid></control><display><type>article</type><title>Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Zhao, Qing-Jv, MD ; Zhang, Xue-Guang, MD ; Wang, Le-Xin, MD, PhD</creator><creatorcontrib>Zhao, Qing-Jv, MD ; Zhang, Xue-Guang, MD ; Wang, Le-Xin, MD, PhD</creatorcontrib><description>Abstract Purpose The study aimed to investigate the association between blood glucose or lactate and the outcomes of severe traumatic brain injury (TBI), and to evaluate the effect of mild hypothermia therapy on glucose and lactate levels. Methods Eighty-one patients with TBI were randomly divided into normothermia (n = 41) and mild hypothermia (n = 40) group. Body temperature of hypothermia group was maintained at 32.7°C for 72 hours. Arterial blood glucose and lactic acid were determined before and after hypothermia therapy. Glasgow Outcome Scale (GOS) score was assessed 3 months after the treatment. Results The mean glucose (7.04 ± 0.51 vs 9.71 ± 1.63 mmol/L, P < .05) in the hypothermia group was lower than in the normothermia group after hypothermia therapy. There were more patients with good neurologic function (GOS 4-5) in the hypothermia group than in the normothermia group (75.0% vs 51.2%, P = .038). Multivariate regression analysis showed that blood glucose greater than 10 mmol/L (adjusted risk ratio, 5.7; 95% confidence interval, 1.4-13.2; P < .05) was an independent predictor for poor neurologic outcomes in these patients, and hypothermia therapy was an independent predictor for favorable outcomes (risk ratio, 4.9; 95% confidence interval, 1.0-15.6; P < .05). No significant association between lactate and GOS scores was identified in the multivariate analysis. Conclusion Hyperglycemia after TBI was associated with poor clinical outcomes, but the predictive value of blood lactate level requires further investigation. Hypothermia therapy improves neurologic outcomes in patients with severe TBI, and reduction in blood glucose may be partially responsible for the improved outcomes.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2010.08.014</identifier><identifier>PMID: 20889287</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Blood Glucose - analysis ; Brain damage ; Brain Injuries - blood ; Brain Injuries - therapy ; Confidence intervals ; Cooling ; Critical Care ; Female ; Follow-Up Studies ; Free radicals ; Glasgow Outcome Scale ; Glucose ; Humans ; Hyperglycemia ; Hypothermia ; Hypothermia, Induced ; Lactate ; Lactic Acid - blood ; Male ; Middle Aged ; Mild hypothermia ; Mortality ; Multivariate analysis ; Neurologic outcome ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Statistical analysis ; Traumatic brain injury ; Treatment Outcome ; Ventilation ; Young Adult</subject><ispartof>Journal of critical care, 2011-06, Vol.26 (3), p.311-315</ispartof><rights>2011</rights><rights>Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-8b517c68b24ba41533cdf92183b0a6cbe7e2ab7baacdd69af7882091a5f48fb3</citedby><cites>FETCH-LOGICAL-c438t-8b517c68b24ba41533cdf92183b0a6cbe7e2ab7baacdd69af7882091a5f48fb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1033241656?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20889287$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Qing-Jv, MD</creatorcontrib><creatorcontrib>Zhang, Xue-Guang, MD</creatorcontrib><creatorcontrib>Wang, Le-Xin, MD, PhD</creatorcontrib><title>Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Purpose The study aimed to investigate the association between blood glucose or lactate and the outcomes of severe traumatic brain injury (TBI), and to evaluate the effect of mild hypothermia therapy on glucose and lactate levels. Methods Eighty-one patients with TBI were randomly divided into normothermia (n = 41) and mild hypothermia (n = 40) group. Body temperature of hypothermia group was maintained at 32.7°C for 72 hours. Arterial blood glucose and lactic acid were determined before and after hypothermia therapy. Glasgow Outcome Scale (GOS) score was assessed 3 months after the treatment. Results The mean glucose (7.04 ± 0.51 vs 9.71 ± 1.63 mmol/L, P < .05) in the hypothermia group was lower than in the normothermia group after hypothermia therapy. There were more patients with good neurologic function (GOS 4-5) in the hypothermia group than in the normothermia group (75.0% vs 51.2%, P = .038). Multivariate regression analysis showed that blood glucose greater than 10 mmol/L (adjusted risk ratio, 5.7; 95% confidence interval, 1.4-13.2; P < .05) was an independent predictor for poor neurologic outcomes in these patients, and hypothermia therapy was an independent predictor for favorable outcomes (risk ratio, 4.9; 95% confidence interval, 1.0-15.6; P < .05). No significant association between lactate and GOS scores was identified in the multivariate analysis. Conclusion Hyperglycemia after TBI was associated with poor clinical outcomes, but the predictive value of blood lactate level requires further investigation. Hypothermia therapy improves neurologic outcomes in patients with severe TBI, and reduction in blood glucose may be partially responsible for the improved outcomes.</description><subject>Adult</subject><subject>Blood Glucose - analysis</subject><subject>Brain damage</subject><subject>Brain Injuries - blood</subject><subject>Brain Injuries - therapy</subject><subject>Confidence intervals</subject><subject>Cooling</subject><subject>Critical Care</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Free radicals</subject><subject>Glasgow Outcome Scale</subject><subject>Glucose</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hypothermia</subject><subject>Hypothermia, Induced</subject><subject>Lactate</subject><subject>Lactic Acid - blood</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mild hypothermia</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neurologic outcome</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Severity of Illness Index</subject><subject>Statistical analysis</subject><subject>Traumatic brain injury</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><subject>Young Adult</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kkuLFEEMxwtR3HH1C3iQAg-eeqxHP6pBBFl8wYoH917UI71TbXfXWI-R_gp-aquZVWEPnhKSX0KSfxB6TsmeEtq-HvejCWbPSAkQsSe0foB2tGm6SrS0eYh2RAhe9XVNL9CTGEdCaMd58xhdsJLpmeh26NcXN1l8WI8-HSDMTuHNquOKA9hsIGI9eW_x7ZSNj4DVYvGkTFLp7Lv5GPypYAvk4Cd_6wz2ORk_l5hb8FElB0uK-KdLBxzhBAFwCirPJWGwDqpAbhlzWJ-iR4OaIjy7s5fo5sP7m6tP1fXXj5-v3l1XpuYiVUI3tDOt0KzWqqYN58YOPaOCa6Jao6EDpnSnlTLWtr0aOiEY6alqhloMml-iV-e2ZfAfGWKSs4sGpkkt4HOUohV93_SkK-TLe-Toc1jKbJISzllN26YtFDtTJvgYAwzyGNyswloguekkR7npJDedJBGy6FSKXty1znoG-7fkjzAFeHMGoFzi5CDIaMohDVgXwCRpvft__7f3ys3kFmfU9B1WiP_2kJFJIr9tn7I9CiWElL0E_w0KcbxY</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Zhao, Qing-Jv, MD</creator><creator>Zhang, Xue-Guang, MD</creator><creator>Wang, Le-Xin, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20110601</creationdate><title>Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury</title><author>Zhao, Qing-Jv, MD ; Zhang, Xue-Guang, MD ; Wang, Le-Xin, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-8b517c68b24ba41533cdf92183b0a6cbe7e2ab7baacdd69af7882091a5f48fb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Blood Glucose - analysis</topic><topic>Brain damage</topic><topic>Brain Injuries - blood</topic><topic>Brain Injuries - therapy</topic><topic>Confidence intervals</topic><topic>Cooling</topic><topic>Critical Care</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Free radicals</topic><topic>Glasgow Outcome Scale</topic><topic>Glucose</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hypothermia</topic><topic>Hypothermia, Induced</topic><topic>Lactate</topic><topic>Lactic Acid - blood</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mild hypothermia</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Neurologic outcome</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Severity of Illness Index</topic><topic>Statistical analysis</topic><topic>Traumatic brain injury</topic><topic>Treatment Outcome</topic><topic>Ventilation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Qing-Jv, MD</creatorcontrib><creatorcontrib>Zhang, Xue-Guang, MD</creatorcontrib><creatorcontrib>Wang, Le-Xin, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Qing-Jv, MD</au><au>Zhang, Xue-Guang, MD</au><au>Wang, Le-Xin, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>26</volume><issue>3</issue><spage>311</spage><epage>315</epage><pages>311-315</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Purpose The study aimed to investigate the association between blood glucose or lactate and the outcomes of severe traumatic brain injury (TBI), and to evaluate the effect of mild hypothermia therapy on glucose and lactate levels. Methods Eighty-one patients with TBI were randomly divided into normothermia (n = 41) and mild hypothermia (n = 40) group. Body temperature of hypothermia group was maintained at 32.7°C for 72 hours. Arterial blood glucose and lactic acid were determined before and after hypothermia therapy. Glasgow Outcome Scale (GOS) score was assessed 3 months after the treatment. Results The mean glucose (7.04 ± 0.51 vs 9.71 ± 1.63 mmol/L, P < .05) in the hypothermia group was lower than in the normothermia group after hypothermia therapy. There were more patients with good neurologic function (GOS 4-5) in the hypothermia group than in the normothermia group (75.0% vs 51.2%, P = .038). Multivariate regression analysis showed that blood glucose greater than 10 mmol/L (adjusted risk ratio, 5.7; 95% confidence interval, 1.4-13.2; P < .05) was an independent predictor for poor neurologic outcomes in these patients, and hypothermia therapy was an independent predictor for favorable outcomes (risk ratio, 4.9; 95% confidence interval, 1.0-15.6; P < .05). No significant association between lactate and GOS scores was identified in the multivariate analysis. Conclusion Hyperglycemia after TBI was associated with poor clinical outcomes, but the predictive value of blood lactate level requires further investigation. Hypothermia therapy improves neurologic outcomes in patients with severe TBI, and reduction in blood glucose may be partially responsible for the improved outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20889287</pmid><doi>10.1016/j.jcrc.2010.08.014</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Blood Glucose - analysis Brain damage Brain Injuries - blood Brain Injuries - therapy Confidence intervals Cooling Critical Care Female Follow-Up Studies Free radicals Glasgow Outcome Scale Glucose Humans Hyperglycemia Hypothermia Hypothermia, Induced Lactate Lactic Acid - blood Male Middle Aged Mild hypothermia Mortality Multivariate analysis Neurologic outcome Predictive Value of Tests Prognosis Severity of Illness Index Statistical analysis Traumatic brain injury Treatment Outcome Ventilation Young Adult |
| title | Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury |
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