Treatment for Traumatic Brain Injury May Be Informed By Glucose Variation

Investigators discovered clinical variables that could inform treatment for patients hospitalized with traumatic brain injury (TBI) to improve clinical outcomes, according to authors of research published in The Lancet and conducted at the Karolinska Institutet in Sweden. Hospitals that consider differences in brain injury biomarkers and glucose variation may be able to provide better personalized treatment based on the injury.¹

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Severe TBI is often treated in the intensive care unit (ICU) setting. It is during this first week of an ICU stay that treatment is critical for patients; TBI can have severe primary and secondary adverse events that impact patient outcomes (especially mortality).¹

But despite there being a range of TBIs based on severity or type, patients at most hospitals will“effectively [receive] the same treatment,” said first author Cecilia Åkerlund, an anesthetist and intensive care specialist at Karolinska University Hospital and researcher at the Department of Physiology and Pharmacology, Karolinska Institutet, Sweden, in the press release.¹

To identify clinical variables which could allow for differentiated treatment based on disease trajectory, investigators at the Karolinska Institutet conducted a study that included a cohort of 1728 patients hospitalized for acute cranial injury. Patient data was originally collected from the prospective and observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort study.²

The study evaluated data on brain injury biomarkers and glucose variation, which consisted of assessing the difference between maximum and minimum glucose concentrations, during the patients’ first week of hospitalization at the ICU. These clinical variables show the severity of the injury.^1,2

Investigators then used a clustering method to separate patients into 6 groups based on brain biomarkers and glucose variation. Among patients with the best prognosis, 4% died after 6months; for patients with the worst prognosis, 65% died after 6 months. Among those patients with a poor prognosis, 41% died during week 1 of their ICU stay.¹

While certain hospitals have begun to clinically monitor brain injury biomarkers, Åkerlund said that it might not be a common practice worldwide. Larger studies with different patient groups are needed to validate the stability of the current method, Åkerlund noted.¹

“If we can do this, it will be an important step towards being better able to personalize the treatment of patients with primarily moderate and severe TBIs,” Åkerlund said in the press release.¹

Study author David Nelson, a consultant at the neurocritical care unit at Karolinska University Hospital and a Karolinska Institutet researcher, said, “Our study supports the notion that serial brain injury biomarkers can play an important part in monitoring the disease trajectory in our brain injury patients.”¹

References

1. Clustering method can better describe the pathological process in patients with traumatic brain injury. Karolinska Institutet. News Release. November 14, 2023. Accessed on November 20, 2023. https://www.eurekalert.org/news-releases/10079882. Åkerlund CAI, Holst A, Bhattacharyay S. Clinical descriptors of disease trajectories in patients with traumatic brain injury in the intensive care unit (CENTER-TBI): a multicentre observational cohort study. Lancet. 2023. doi:10.1016/S1474-4422(23)00358-7