Cui Shizhen, Xu Daiqi, Xiong Han, Zhuang Yimin, He Zhaohui
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Biomol Biomed. 2025 Jan 14;25(2):291-303. doi: 10.17305/bb.2024.10865.
Stress-induced hyperglycemia (SIH) is common in patients with traumatic brain injury (TBI) and has been suggested to influence mortality rates. This meta-analysis aims to evaluate the impact of SIH on mortality in TBI patients without preexisting diabetes mellitus (DM). A comprehensive search was performed in Medline, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI) databases up to May 15, 2024, to retrieve relevant studies. Observational studies reporting the incidence of all-cause mortality among TBI patients without preexisting DM, comparing those with and without SIH, were included. The association between SIH and all-cause mortality was analyzed using risk ratios (RR) and 95% confidence intervals (CI) with a random-effects model. Twelve cohort studies comprising 15 datasets with 16,387 TBI patients were included. The pooled analysis showed that SIH was associated with a higher risk of all-cause mortality (RR: 2.00, 95% CI: 1.72-2.33, P < 0.001), with mild heterogeneity (I² = 25%). Sensitivity analysis confirmed the robustness of these findings. Subgroup analyses indicated no significant differences based on study design, patient age, gender proportion, SIH definition, or follow-up duration. However, the association was slightly weaker but still significant in studies using multivariate analyses (RR: 1.76) compared to univariate analyses (RR: 2.69). In conclusion, SIH was associated with a higher risk of all-cause mortality in TBI patients without preexisting DM. Further research should explore the underlying mechanisms and optimal management strategies for SIH in this population.
应激性高血糖（SIH）在创伤性脑损伤（TBI）患者中很常见，并且有人认为它会影响死亡率。本荟萃分析旨在评估SIH对无糖尿病（DM）病史的TBI患者死亡率的影响。截至2024年5月15日，我们在Medline、Web of Science、Embase、万方和中国知网（CNKI）数据库中进行了全面检索，以检索相关研究。纳入了观察性研究，这些研究报告了无DM病史的TBI患者中全因死亡率的发生率，并比较了有和没有SIH的患者。使用风险比（RR）和95%置信区间（CI），采用随机效应模型分析SIH与全因死亡率之间的关联。纳入了12项队列研究，包括15个数据集，共16387例TBI患者。汇总分析表明，SIH与全因死亡率风险较高相关（RR：2.00，95%CI：1.72 - 2.33，P < 0.001），异质性较小（I² = 25%）。敏感性分析证实了这些发现的稳健性。亚组分析表明，基于研究设计、患者年龄、性别比例、SIH定义或随访时间，没有显著差异。然而，与单变量分析（RR：2.69）相比，多变量分析的研究中这种关联略弱但仍具有统计学意义（RR：1.76）。总之，在无DM病史的TBI患者中，SIH与全因死亡率风险较高相关。进一步的研究应探索该人群中SIH的潜在机制和最佳管理策略。
