Gender Differences in Glucose Variability after Severe Trauma

Gender differences in the physiological response to trauma can affect outcome. Both hyperglycemia and blood glucose (BG) variability predict a poor outcome after trauma. This study examined the hypothesis that both BG levels and the degree of BG variability after trauma are gender-specific and correlate with mortality and morbidity. A retrospective observational cohort study of 1915 trauma patients requiring critical care was performed. Admission BG as well as all BG values obtained during the first week while in the intensive care unit were analyzed. In each patient, the mean BG and the degree of BG variability were calculated. A total of 1560 males and 355 females were studied with an overall mortality rate of 12 per cent. Seventy-six per cent of deaths had a BG greater than 125 mg/dL on admission and as BG variability worsened, the mortality rate also increased. There was a significant difference in male BG variability when comparing survivors with nonsurvivors. Female BG variability did not predict mortality. Failed glucose homeostasis is an important marker of endocrine dysfunction after severe injury. Increased BG variability in males is associated with a higher mortality rate. In females, mortality cannot be predicted based on BG levels or BG variability. These data have significant implications for gender-related differences in postinjury management.