Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma
Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injurie...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-09-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/11/9/1667 |
| _version_ | 1829452842752016384 |
|---|---|
| author | Janett Kreutziger Margot Fodor Dagmar Morell-Hofert Florian Primavesi Stefan Stättner Eva-Maria Gassner Stefan Schmid Christopher Rugg |
| author_facet | Janett Kreutziger Margot Fodor Dagmar Morell-Hofert Florian Primavesi Stefan Stättner Eva-Maria Gassner Stefan Schmid Christopher Rugg |
| author_sort | Janett Kreutziger |
| collection | DOAJ |
| description | Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (<i>n</i> = 456), spleen (<i>n</i> = 375) and kidney (<i>n</i> = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAS<b>T</b> III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, <i>p</i> < 0.0001) and kidney injuries (median 10.6 mmol/L, <i>p</i> = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, <i>p</i> < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury. |
| first_indexed | 2024-03-10T07:45:48Z |
| format | Article |
| id | doaj.art-b910bb50df1f4c3fb3af1bf69b8e3ea2 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T07:45:48Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-b910bb50df1f4c3fb3af1bf69b8e3ea22023-11-22T12:40:34ZengMDPI AGDiagnostics2075-44182021-09-01119166710.3390/diagnostics11091667Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver TraumaJanett Kreutziger0Margot Fodor1Dagmar Morell-Hofert2Florian Primavesi3Stefan Stättner4Eva-Maria Gassner5Stefan Schmid6Christopher Rugg7Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Radiology, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of General, Visceral and Vascular Surgery, Salzkammergut Klinikum Vöcklabruck, 4840 Vöcklabruck, AustriaDepartment of General, Visceral and Vascular Surgery, Salzkammergut Klinikum Vöcklabruck, 4840 Vöcklabruck, AustriaDepartment of Radiology, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaBackground: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (<i>n</i> = 456), spleen (<i>n</i> = 375) and kidney (<i>n</i> = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAS<b>T</b> III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, <i>p</i> < 0.0001) and kidney injuries (median 10.6 mmol/L, <i>p</i> = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, <i>p</i> < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.https://www.mdpi.com/2075-4418/11/9/1667stress hyperglycemialiver injurykidney injuryspleen injurytraumaoutcome |
| spellingShingle | Janett Kreutziger Margot Fodor Dagmar Morell-Hofert Florian Primavesi Stefan Stättner Eva-Maria Gassner Stefan Schmid Christopher Rugg Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma Diagnostics stress hyperglycemia liver injury kidney injury spleen injury trauma outcome |
| title | Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma |
| title_full | Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma |
| title_fullStr | Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma |
| title_full_unstemmed | Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma |
| title_short | Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma |
| title_sort | absence of stress hyperglycemia indicates the most severe form of blunt liver trauma |
| topic | stress hyperglycemia liver injury kidney injury spleen injury trauma outcome |
| url | https://www.mdpi.com/2075-4418/11/9/1667 |
| work_keys_str_mv | AT janettkreutziger absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT margotfodor absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT dagmarmorellhofert absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT florianprimavesi absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT stefanstattner absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT evamariagassner absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT stefanschmid absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma AT christopherrugg absenceofstresshyperglycemiaindicatesthemostsevereformofbluntlivertrauma |