Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients.
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.
Bochicchio
Grant V
GV
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
Bochicchio
Kelly M
KM
Joshi
Manjari
M
Ilahi
Obeid
O
Scalea
Thomas M
TM
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*
D001786:Blood Glucose