title: Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition.
abstract: OBJECTIVE
  Hyperglycemia is associated with poor clinical outcomes and mortality in myocardial infarction, stroke, and general hospital patients. However, there are few data regarding the effect of hyperglycemia on outcomes in patients receiving total parenteral nutrition (TPN), a therapy that predisposes patients to hyperglycemia. The aim of this study was to determine whether elevated blood glucose levels are associated with adverse outcomes in patients receiving TPN.
  
  
  METHODS
  A retrospective analysis was undertaken from the medical records of 111 patients (122 treatment episodes) receiving TPN. All patients had blood drawn daily for the measurement of blood glucose levels. Outcome measures were assessed as a function of mean daily blood glucose levels while receiving TPN.
  
  
  RESULTS
  Increased blood glucose levels were associated with an increased risk of cardiac complications (odds ratio 1.61, 95% CI 1.09-2.37, P = 0.02), infection (1.4, 1.08-1.82, P = 0.01), systemic sepsis (1.36, 1.00-1.86, P = 0.05), acute renal failure (1.47, 1.00-2.17, P = 0.05), and death (1.77, 1.23-2.52, P < 0.01). When the data were examined by quartiles of blood glucose levels, the mortality of subjects in the highest quartile was 10.9 times (95% CI 2.0-60.5, P < 0.01) that of subjects in the lowest quartile, and the risk of developing any complication was 4.3 times higher (1.4-13.1, P < 0.01). These effects were independent of age, sex, or prior diabetes status.
  
  
  CONCLUSIONS
  Hyperglycemia is a predictor of poor outcomes in patients receiving TPN. The confirmation of a relation between blood glucose levels and adverse outcomes provides support for tight glycemic control in these patients.
authors.affiliation: Centre for Diabetes & Endocrinology Research, Westmead Hospital, Westmead, NSW 2145, Australia. wah@westgate.wh.usyd.edu.au
authors.forename: N Wah
authors.initials: NW
authors.lastname: Cheung
authors.forename: Brett
authors.initials: B
authors.lastname: Napier
authors.forename: Cathy
authors.initials: C
authors.lastname: Zaccaria
authors.forename: John P
authors.initials: JP
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin