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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470453/ https://www.ncbi.nlm.nih.gov/pubmed/34574008 http://dx.doi.org/10.3390/diagnostics11091667 |
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author | Kreutziger, Janett Fodor, Margot Morell-Hofert, Dagmar Primavesi, Florian Stättner, Stefan Gassner, Eva-Maria Schmid, Stefan Rugg, Christopher |
author_facet | Kreutziger, Janett Fodor, Margot Morell-Hofert, Dagmar Primavesi, Florian Stättner, Stefan Gassner, Eva-Maria Schmid, Stefan Rugg, Christopher |
author_sort | Kreutziger, Janett |
collection | PubMed |
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 (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST 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, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 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. |
format | Online Article Text |
id | pubmed-8470453 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-84704532021-09-27 Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma Kreutziger, Janett Fodor, Margot Morell-Hofert, Dagmar Primavesi, Florian Stättner, Stefan Gassner, Eva-Maria Schmid, Stefan Rugg, Christopher Diagnostics (Basel) Article 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 (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST 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, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 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. MDPI 2021-09-13 /pmc/articles/PMC8470453/ /pubmed/34574008 http://dx.doi.org/10.3390/diagnostics11091667 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kreutziger, Janett Fodor, Margot Morell-Hofert, Dagmar Primavesi, Florian Stättner, Stefan Gassner, Eva-Maria Schmid, Stefan Rugg, Christopher Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma |
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 | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470453/ https://www.ncbi.nlm.nih.gov/pubmed/34574008 http://dx.doi.org/10.3390/diagnostics11091667 |
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