Persistent hyperglycemia is predictive of outcome in critically ill trauma patients.
OBJECTIVE
Our objectives were to determine whether persistent hyperglycemia was predictive of outcome in critically ill trauma patients.


METHODS
Prospective data were collected daily on 942 consecutive trauma patients admitted to the ICU over a 2-year period. Patients were stratified by serum glucose level from day 1 to day 7 (low = 0-139 mg/dL, medium = 140-219 mg/dL, and high >220 mg/dL) age, gender, and ISS. Patients were further stratified by pattern of glucose control (all low, all moderate, all high, improving, worsening, highly variable (HV). Outcome was measured by ventilator days, infection, hospital (HLOS) and ICU (ILOS) length of stay and mortality. Multiple linear regression models were used to determine level of significance.


RESULTS
71% were victims of blunt trauma. The majority (74%) were male with a mean ISS of 21.3 +/- 15. 41% of patients acquired an infection. Patients with medium, high, worsening, and highly variable hyperglycemia were found to have increased ILOS, HLOS, ventilator days, infection rate and mortality by univariate analysis (p < 0.01). When controlling for age, ISS, and glucose pattern, patients with high, worsening and HV hyperglycemia were most predictive of increased ventilator days, ILOS, HLOS, infection and mortality. (p < 0.01).


CONCLUSIONS
Trauma patients with persistent hyperglycemia have a significantly greater degree of morbidity and mortality. A prospective randomized controlled study instituting aggressive hyperglycemic control is warranted.
Bochicchio
Grant V
GV
R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA. gbochicchio@umm.edu
Sung
Jin
J
Joshi
Manjari
M
Bochicchio
Kelly
K
Johnson
Steven B
SB
Meyer
Walter
W
Scalea
Thomas M
TM
D000328:Adult; D017677:Age Distribution; D001786:Blood Glucose / Q000032:analysis; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology*; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008396:Maryland / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000097:blood* / Q000453:epidemiology*; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000097:blood / Q000453:epidemiology
D001786:Blood Glucose