Correlation Of Blood Glucose Fluctuation On The Prognosis Of Critical Craniocerebral Disease Patients

Objective：Stress hyperglycemia, which is ubiquitous among intensive care unit (ICU) patients,may jeopardize the functions of multiple organs primarily in two manners, includingpersistent hyperglycemia and substantial blood glucose level fluctuation (also known asblood glucose variability). The latter influences the chronic complications of diabetespatients more significantly than the former does, and they synergetically and cooperativelyaffect the prognosis. To determine the correlation between glucose fluctuation and theprognosis of critical craniocerebral disease patients in ICU.Methods：A prospective study involing80critical craniocerebral disease patients，APACHE-Ⅱvalue in admission day≥15, the duration of intensive care unit (ICU) stays≥3days,4≤the value of GCS≤8in our hospital’s ICU was conduced. Blood glucose monitoring andprognosis observation were performed for the80patients admitted in ICU form September2012to July2013.Blood glucose monitoring terminal was72hours after admitting in ICU,prognosis was observed for28days after the end of turning into ICU. Acute physiologyand chronic health evaluation Ⅱ (APACHE-Ⅱ) scores when transferred into ICU, theaverage blood glucose (GluAve),blood glucose variability [glucose standard deviation(GluSD),coefficient of variation glucose (GluCV), the glycemic instability index (GLI) ofthe1st day, the2nd day, the3rd day and72hours]were calculated. According to thepatients’ prognosis on the28th day, the78patients were divided into survival group (n=40)and death group (n=38), and the APACHE-Ⅱscore,blood glucose variability, insulinresistance, the levels of hs-CRP and NSE,28-day mortality were compared in two groups.Results： （1） Compared with survivor group, in death group, the levels of APACHE-Ⅱ、hs-CRP、TNF-α and NSE were significantly increased [APACHE-Ⅱs core：(23.8±6.5) vs.(21.6±5.4)，hs-CRP：（108.9±56.5)mg/L vs.(25.6±16.2)mg/L，TNF-α：（50.6±7.3）vs.（40.7±6.2）ng/L，NSE：(64.6±23.9)ug/L vs.(22.3±5.6)ug/L，all Ρ<0.05].Pearsoncorrelation analysis showed that APACHE-Ⅱscores correlated closely withNSE(P<0.01).（2）The index of blood glucose variability (GluSD、GluCV、GLI-1、GLI-3d and therate of hypoglycemia) of nonsurvivors were higher than survivors[GluSD：(3.77±1.93)mmol/L vs.(2.26±1.01)mmol/L， GluCV：(0.38±0.11) vs.(0.27±0.08)， GLI-1：7.26(8.94) vs.1.23(1.28)， GLI-3d：6.40(7.59) vs.0.82(1.11)，all Ρ<0.05],but the levels of GluAdm and GluAve of two groups have nosignificant difference (all Ρ>0.05).（3）The index of insulin resistance （HOMA-IR、HOMA-β、72hours total dosageof intravenous insulin) of nonsurvivor group are significantly higher than survivor group(all Ρ<0.05).Spearman correlation analysis showed that GLI-3d correlated closely withHOMA-IR、hs-CRP and TNF-α (r=0.665，0.539，0.491；P<0.01）.（4）When ROC was applied,the area under the curve (AUC) of GLI-3d was0.901±0.042, it was higher than that of GLI-1、GLI-2and GLI-3(all Ρ<0.05).Conclusions：Fluctuation of blood glucose has tight relation to short-term mortaility (28days) in theCritical craniocerebral disease patients. Therefore, it is imperative to stabilize the bloodglucose level while lowering it in the treatment of critical craniocerebral disease patients.