title: Time and degree of glycemic derangement are associated with increased mortality in trauma patients in the setting of tight glycemic control.
abstract: BACKGROUND
  Tight glucose control (TGC) may reduce mortality in critically ill trauma patients. We hypothesize that euglycemia is beneficial, and a measure considering time and degree of hyperglycemia is most associated with mortality.
  
  
  METHODS
  We performed a review of intensive care unit trauma patients admitted for more than 3 days between January 2005 and December 2007 on a TGC protocol with a goal of 80 to 110 mg/dL. Hyperglycemic, hypoglycemic, and euglycemic time ranges, and area of interpolated curves above and below 80 to 110 mg/dL were assessed. Associations with mortality were based on logistic regression models adjusted for age, injury severity score, and admission Glasgow Coma Scale score.
  
  
  RESULTS
  A total of 546 patients were identified, and 68 (13%) died. Time spent as hyperglycemic (P = .29) and hyperglycemic area under the curve (P = .58) were not associated with mortality; hyperglycemic area/time (P = .01) was associated with mortality. Regarding hypoglycemia, area over the curve (P = .009) and time spent as hypoglycemic (P = .002) were associated with mortality.
  
  
  CONCLUSIONS
  TGC prevents prolonged, high degrees of hyperglycemia; avoiding hypoglycemia likely provides mortality benefit for trauma patients.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. Corneille@uthscsa.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Corneille
authors.forename: Celina
authors.initials: C
authors.lastname: Villa
authors.forename: Steven
authors.initials: S
authors.lastname: Wolf
authors.forename: Joel E
authors.initials: JE
authors.lastname: Michalek
authors.forename: Inkyung
authors.initials: I
authors.lastname: Jung
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dent
authors.forename: Deborah
authors.initials: D
authors.lastname: Mueller
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014947:Wounds and Injuries / Q000097:blood* / Q000401:mortality
chemical_list: D001786:Blood Glucose