title: Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients.
abstract: OBJECTIVE
  To evaluate whether acute glucose elevation (AGE) is predictive of infection and outcome in critically injured trauma patients during the first 14 days of ICU admission.
  
  
  METHODS
  A prospective study was conducted on 2200 patients admitted to the ICU over a 2 1/2 year period. The diagnosis of infection was made via a multidisciplinary fashion utilizing CDC criteria. After early glucose stabilization occurred (no significant change for 48 hours after admission) monitoring for AGE was performed utilizing a computational and graded algorithmic model. Iatrogenic causes of AGE were excluded. Stepwise regression models were performed controlling for age, gender, mechanism of injury, diabetes, injury severity, and APACHE 2 score. ROC curves were used to evaluate the positive predictive value of the test.
  
  
  RESULTS
  Seventy-seven percent of the patients in the cohort were males, and were admitted for blunt injuries (n = 1870 or 85%). The mean age, Injury Severity Score, and APACHE score were 44 ± 20 years, 29 ± 13, and 13 ± 7, respectively. The mean admission serum glucose value was 141 ± 36 mg/dL (range, 64-418 mg/dL). A total of 616 (28%) patients were diagnosed with an infection during the first 14 days of admission. AGE had a 91% positive predictive value for infection diagnosis. In addition, AGE was associated with a significant increase in ventilator, ICU, and hospital days as well as mortality even when adjusted for age, injury severity, APACHE score, and diabetes (P < 0.001).
  
  
  CONCLUSIONS
  AGE is a highly accurate predictor of infection and should stimulate clinicians to identify a new source of infection.
authors.affiliation: Division of Clinical and Outcomes Research, Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. gbochicchio@umm.edu
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Bochicchio
authors.forename: Manjari
authors.initials: M
authors.lastname: Joshi
authors.forename: Obeid
authors.initials: O
authors.lastname: Ilahi
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D018806:APACHE; D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D014946:Wound Infection / Q000097:blood* / Q000175:diagnosis; D014947:Wounds and Injuries / Q000097:blood*
chemical_list: D001786:Blood Glucose