naa a22 4500 510799493 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9919-x doi (NATIONALLICENCE)springer-10.1007/s12028-013-9919-x Reduced Brain/Serum Glucose Ratios Predict Cerebral Metabolic Distress and Mortality After Severe Brain Injury [Elektronische Daten] [Pedro Kurtz, Jan Claassen, J. Schmidt, Raimund Helbok, Khalid Hanafy, Mary Presciutti, Hector Lantigua, E. Connolly, Kiwon Lee, Neeraj Badjatia, Stephan Mayer] 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 80-120mg/dL (4.4-6.7mmol/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 mortality. Results: A total of 5,187 neuromonitoring hours over 300days were analyzed. Mean serum glucose was 133mg/dL (7.4mmol/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 5.0mmol/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. Springer Science+Business Media New York, 2013 Brain injury nationallicence Coma nationallicence Cerebral microdialysis nationallicence Glucose nationallicence Metabolism nationallicence Glucose transport nationallicence Kurtz Pedro Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Claassen Jan Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Schmidt J. Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Helbok Raimund Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Hanafy Khalid Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Presciutti Mary Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Lantigua Hector Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Connolly E. Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Lee Kiwon Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Badjatia Neeraj Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Mayer Stephan Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 311-319 1541-6933 19:3<311 2013 19 12028 https://doi.org/10.1007/s12028-013-9919-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9919-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kurtz Pedro Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Claassen Jan Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Schmidt J. Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Helbok Raimund Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Hanafy Khalid Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Presciutti Mary Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Lantigua Hector Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Connolly E. Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Lee Kiwon Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Badjatia Neeraj Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 700 1- Mayer Stephan Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, Milstein Hospital 8 Center, 177 Fort Washington Ave, 10032, New York, NY, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 311-319 1541-6933 19:3<311 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer