# Association between sustained moderate hyperglycemia within first 48 hours and poor functional outcome after polytrauma: A retrospective cohort study

## TL;DR

This study found that moderate high blood sugar in the first 48 hours after severe injury is linked to worse recovery outcomes in ICU patients.

## Contribution

The study introduces time-based glucose metrics as potential risk markers for functional outcomes in polytrauma patients.

## Key findings

- Prolonged moderate hyperglycemia in the first 48 hours was independently linked to poor functional outcomes.
- Cumulative glycemic exposure showed stronger associations than admission or average glucose levels.
- Hyperglycemia was higher during the early 'ebb' phase compared to the later 'flow' phase.

## Abstract

Stress-induced hyperglycemia is a frequent metabolic response to polytrauma. To date, studies primarily analyzed its association with mortality; however, its effect on functional outcomes remain unclear. This study investigated the association between sustained hyperglycemia across metabolic phases and functional outcomes in polytraumatized ICU patients.

This retrospective single-center observational study included 176 adult ICU polytrauma patients admitted to a German level 1 university trauma center (2013–2023). Blood ​glucose was quantified using admission values, time-weighted averages, variability and time-unified hyperglycemic rate (TUHyperR; cutoffs 140/160/180 mg/dL) across the early “ebb” (≤ 48 h) and later “flow” (> 48 h) metabolic phases. Primary endpoint was functional outcome using Glasgow outcome scale (GOS; unfavorable GOS ≤ 3). Temporal trends were analyzed using mixed-effects models, and associations with outcomes were assessed using multivariable logistic regression.

Patients with unfavorable outcomes (39.2%) had higher cumulative hyperglycemic exposure throughout their ICU stay. Hyperglycemia was consistently higher during ebb than flow phase. Moderate hyperglycemia during the ebb phase was also in multivariable analysis most discriminative: TUHyperR>140 mg/dL (OR 1.015, 95%-CI [1.004–1.025], p = 0.008) and TUHyperR>160 mg/dL (OR 1.016, 95%-CI [1.003–1.030], p = 0.017) were independently associated with unfavorable outcomes, whereas TUHyperR>180 mg/dL, admission, mean glucose values as well as glycemic variability were not.

Prolonged moderate hyperglycemia within the first 48 h after polytrauma was independently associated with poor functional outcome at hospital discharge. These exploratory findings support the value of cumulative glycemic exposure as a potential risk marker and highlight the need for prospective studies to determine whether time-based glucose metrics might improve risk stratification and guide metabolic management in polytrauma ICU patients.

The online version contains supplementary material available at 10.1007/s00068-026-03099-3.