Dynamic Changes in Segmented Neutrophil-to-Monocyte Ratio in Trauma Patients with Stress-Induced Hyperglycemia: A Retrospective Study

Abstract

Stress-induced hyperglycemia (SIH) is commonly observed in patients with trauma and is associated with increased morbidity and mortality. The segmented neutrophil-to-monocyte ratio (SeMo) serves as a biomarker of inflammation and potentially reflects the severity of the stress response to trauma. This study investigated the relationships between SIH, dynamic changes in SeMo, and patient outcomes in a trauma intensive care unit (ICU). A retrospective analysis was conducted using data from adult patients with trauma admitted to a Level I trauma center in Southern Taiwan over 13 years. Patients were divided into two groups based on the presence of SIH or non-diabetic normoglycemia (NDN). The dynamic SeMo was calculated as the difference in the SeMo from admission to 48-72 hours after admission. Outcomes were compared using descriptive statistics, chi-square tests, and Student's t-tests. Of the 1,030 included patients, those with SIH had a significantly higher SeMo (20.3 vs. 15.2, P = 0.001) and a greater change in dynamic SeMo (1.2 vs. -4.0, P = 0.017) than those with NDN. Among patients with SIH, the deceased group had a higher SeMo (26.4 vs. 18.4, P = 0.022), but there was no difference in dynamic SeMo among the survivors. In the overall cohort and the NDN subgroups, dynamic SeMo was not associated with mortality. However, factors such as older age, lower Glasgow Coma Scale score, higher Injury Severity Score, and presence of end-stage renal disease were more strongly associated with increased mortality. In patients with trauma in ICU, SIH was linked to an increased SeMo and greater changes in dynamic SeMo; however, these changes did not directly predict mortality. It is important to note that an elevated SeMo may be observed in patients with SIH, but not in patients with NDN. This finding should be considered to avoid unnecessary therapies.