Hyperglycemia correlates with outcomes in patients receiving total parenteral nutrition.
BACKGROUND
Hyperglycemia is associated with higher mortality rates after myocardial infarction, stroke, and in critically ill patients. This study was made to determine the associations between hyperglycemia and adverse outcomes in patients receiving total parenteral nutrition (TPN).


METHODS
A retrospective cohort study included total 457 patients (age, 66.4 +/- 16.3 years) receiving TPN in 2004. The patients were divided by mean glucose level into quartiles: quartile 1 (<114 mg/dL, Q1), quartile 2 (114 to 137 mg/dL, Q2), quartile 3 (137 to 180 mg/dL, Q3), and quartile 4 (>180 mg/dL, Q4). A logistic regression analysis was performed to determine whether the degree of hyperglycemia was associated with the adverse outcomes.


RESULTS
The odds ratio of death was significantly increased in quartile 2 (OR, 2.1 [95% CI: 1.1 to 4.0]) (P = 0.02), quartile 3 (OR, 2.3 [95% CI: 1.2 to 4.5]) (P = 0.01), and quartile 4 (OR, 5.0 [95% CI: 2.4 to 10.6]) (P < 0.01) as compared with quartile 1. Each 10-mg/dL increase in mean blood glucose level was associated with an increased risk factor of infection (OR, 1.09 [95% CI: 1.05 to 1.13]) (P < 0.01), cardiac complications (OR, 1.10 [95% CI: 1.03 to 1.17]) (P < 0.01), acute renal failure (OR, 1.07 [95% CI: 1.03 to 1.11]) (P < 0.01), and respiratory failure (OR, 1.08 [95% CI: 1.02 to 1.14]) (P < 0.01). The risk of adverse outcomes increased with hyperglycemia, independent of age, sex, body weight, prior diagnosis of diabetes, ICU stay, insulin therapy, blood sugar readings before TPN treatment, and frequency of blood sugar measurements.


CONCLUSIONS
Hyperglycemia in patients receiving TPN correlates with morbidities and mortality. A prospective, randomized, controlled study instituting aggressive hyperglycemic control is required to determine whether the control of blood glucose can improve outcomes in patients receiving TPN.
Lin
Liang-Yu
LY
Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan.
Lin
Han-Chieh
HC
Lee
Pui-Ching
PC
Ma
Wen-Ya
WY
Lin
Hong-Da
HD
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose