title: Admission hyperglycemia as a prognostic indicator in trauma.
abstract: OBJECTIVE
  The purpose of this study was to assess the utility of two levels of hyperglycemia as predictors for mortality and infectious morbidity in traumatically injured patients.
  
  
  METHODS
  All patients >or= 17 years old presenting to a Level I trauma center as a "trauma alert" or a "trauma code" from January 1, 2000, through December 31, 2000, were reviewed. Hypoglycemic patients (glucose concentration < 70 mg/dL) were excluded (n = 4). Patients were considered hyperglycemic with an admission glucose concentration > 200 mg/dL (moderate hyperglycemia) or an admission glucose concentration in the upper quartile for the group (mild hyperglycemia [glucose concentration > 135 mg/dL]).
  
  
  RESULTS
  Seven hundred thirty-eight patients were included in the study. Hyperglycemia was associated with increased mortality among both patients with moderate hyperglycemia (34.1% vs. 3.7%, p < 0.01) and those with mild hyperglycemia (15.5% vs. 2%, p < 0.01) compared with corresponding normoglycemic groups. Hyperglycemia proved to be an independent predictor of mortality and of hospital and intensive care unit length of stay after multiple logistic regression while controlling for age, Injury Severity Score, Revised Trauma Score, and gender. Infectious complications, including pneumonia (9.4% vs. 2%, p = 0.001), urinary tract infections (6.6% vs. 1.4%, p = 0.001), wound infections (4.9% vs. 0.6%, p = 0.039), and bacteremia (5% vs. 1.1%, p = 0.004), were significantly increased in patients with elevated glucose concentrations. Hyperglycemia is an independent predictor of increased infectious morbidity controlling for age, gender, and Injury Severity Score in multiple logistic regression models.
  
  
  CONCLUSIONS
  Hyperglycemia independently predicts increased intensive care unit and hospital length of stay and mortality in the trauma population. It is associated with increased infectious morbidity. These associations hold true for mild hyperglycemia (glucose concentration > 135 mg/dL) and moderate hyperglycemia (glucose concentration > 200 mg/dL).
authors.affiliation: Department of Surgery, Christian Care Health Services, Newark, Delaware, USA.
authors.forename: Saikrishna
authors.initials: S
authors.lastname: Yendamuri
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Fulda
authors.forename: Glen H
authors.initials: GH
authors.lastname: Tinkoff
mesh_terms: D000328:Adult; D001786:Blood Glucose; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality
chemical_list: D001786:Blood Glucose