Increased insulin levels in traumatic brain injury tied to DVT: Study

The study published in Neurocritical Care found that elevated insulin levels during this period (14 days) may indicate insulin resistance related to platelet hyperactivity and thus raise DVT risk.

To clarify whether insulin resistance underlies the development of DVT in patients with severe traumatic brain injury, Min Zhou, University of Science and Technology of China, Hefei, People's Republic of China, and colleagues analyzed the association between plasma insulin levels and DVT in patients with severe TBI.

For this purpose, the researchers conducted a prospective observational study of 73 patients. They measured glucose, insulin, inflammatory factors, glucagon-like peptide 1 (GLP-1), and hematological profiles during the first 14 days after TBI. Tracking of ultrasonic surveillance of DVT was done.

To determine the factors that distinguished patients with and without DVT or with and without insulin therapy, A two-way analysis of variance was used. The authors separately conducted partial correlations of insulin levels with all the variables in patients with DVT or without DVT. DVT-associated factors were analyzed by multivariable logistic regression. An assessment of neurological outcomes six months after TBI was done.

The study's main findings were as follows:

• Among patients with a mean age of, DVT developed in 27% of the patients on a median of 10.4 days, with higher scores of Acute Physiology and Chronic Health Evaluation II but similar TBI severity and Sequential Organ Failure Assessment scores.
• DVT patients were more likely to receive insulin therapy than those without DVT (60% vs. 28%); hence, they had higher levels of 14-day insulin. However, insulin levels were similar between patients with DVT and those without DVT in a subgroup of patients who received insulin therapy (n = 27) and those without insulin therapy (n = 46).
• The platelet profile notably distinguished between patients with and without DVT. Remarkably, none of the two groups' blood cell counts coagulation profiles, or inflammatory mediators varied.
• Patients who received insulin therapy had significantly higher insulin, glucose, and GLP-1 levels and were more likely to develop DVT (60% vs. 15%) along with simultaneous platelet depletion.
• Insulin levels correspond with glucose, GLP-1 levels, and platelet count exclusively in patients without DVT. Conversely, in DVT patients, insulin is negatively associated with GLP-1 levels.
• Age and elevated insulin levels on days 4–7 were independently associated with DVT.
• Patients with insulin therapy also showed bad Glasgow Outcome Scale scores.

The researchers conclude, "elevated insulin levels in the first 14 days after TBI may be indicative of insulin resistance, which is associated with platelet hyperactivity, thus raising DVT risk."

Reference:

Du, M., Zhang, QH., Tang, R. et al. Prognostic Significance of Plasma Insulin Level for Deep Venous Thrombosis in Patients with Severe Traumatic Brain Injury in Critical Care. Neurocrit Care (2022). https://doi.org/10.1007/s12028-022-01588-y