Effects on Outcomes of Hyperglycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury

Neurotrauma Reports, 2021 · DOI: 10.1089/neur.2020.0042 · Published: January 1, 2021

Spinal Cord Injury Endocrinology Neurology

Simple Explanation

This study looks at the impact of high blood sugar (hyperglycemia) on people who have suffered a spinal cord injury. It aims to understand if high blood sugar levels in the days following the injury affect their survival and recovery. The study found that high blood sugar levels on day 7 after the injury were linked to higher death rates within the first year. However, high blood sugar in the initial days after the injury didn't seem to affect how well people recovered neurologically. Interestingly, having high blood sugar levels at day 7 was associated with lower functional scores, meaning people had more difficulty with daily activities, within the first year after the injury. This suggests managing blood sugar might be important for long-term recovery.

Study Duration

1 Year

Participants

499 (76 females and 423 males)

Evidence Level

Level 3, Retrospective cohort study

Key Findings

1
Hyperglycemia at day 7 post-injury was associated with signiﬁcantly greater mortality rates within the ﬁrst year after acute traumatic SCI.
2
Hyperglycemia during the hyperacute stage was not associated with neurological recovery at 6 weeks, 6 months, or 1 year following acute traumatic SCI.
3
Hyperglycemia at day 7 post-injury was signiﬁcantly correlated with greater degree of disability as assessed using the FIM score within the ﬁrst year following acute traumatic SCI.

Research Summary

This retrospective cohort study examined the potential effects on outcomes of hyperglycemia in the hyperacute stage after acute traumatic SCI. Hyperglycemia diagnosed at day 7 post-injury was associated with signiﬁcantly greater mortality rates post-SCI. Although hyperglycemia during the hyperacute stage was not associated with neurological recovery, hyperglycemia at day 7 may adversely affect functional recovery within the ﬁrst year post-SCI.

Practical Implications

Glycemic Control Importance

Maintaining stable blood sugar levels, especially around day 7 post-SCI, might be crucial for improving long-term survival and functional outcomes.

Targeted Interventions

Focusing on interventions to manage hyperglycemia in SCI patients could potentially reduce mortality rates and enhance functional recovery.

Further Research Needed

Further research is needed to determine the optimal glycemic target for managing patients with acute traumatic SCI, balancing the risks of both hyperglycemia and hypoglycemia.

Study Limitations

1
The retrospective nature of this study precluded collection of other potential confounders.
2
Data on pre-injury diabetes mellitus as a potential confounder were missing in the NASCIS-3 database.
3
Participants in the NASCIS-3 were recruited from 1991 to 1995, when some aspects of pre-hospital, acute spine care, and rehabilitation practices could have been discrepant from the current guidelines.

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