Research Reports - Reduced brain/serum glucose ratios predict cerebral metabolic distress and mortality after severe brain injury

Neurocrit Care. 2013 Oct 1

Kurtz P, Claassen J, Schmidt JM, Helbok R, Hanafy KA, Presciutti M, Lantigua H, Connolly ES, Lee K, Badjatia N, Mayer SA

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
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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