title: Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit.
abstract: OBJECTIVE
  The aim of this study was to evaluate the association between stress-induced hyperglycemia and infectious complications in nondiabetic orthopedic trauma patients admitted to the intensive care unit (ICU).
  
  
  METHODS
  : This study was a retrospective review.
  
  
  METHODS
  The study was conducted at an academic level-1 trauma center.
  
  
  METHODS
  One hundred and eighty-seven consecutive trauma patients with isolated orthopedic injuries were studied.
  
  
  METHODS
  : Blood glucose values during initial hospitalization were evaluated. The admission blood glucose (BG) and hyperglycemic index (HGI) were determined for each patient.
  
  
  METHODS
  Perioperative infectious complications: pneumonia, urinary tract infection (UTI), surgical-site infection (SSI), sepsis were the outcome measures.
  
  
  RESULTS
  An average of 21.5 BG values was obtained for each patient. The mean ICU and hospital length of stay was 4.0 ± 4.9 and 10.0 ± 8.1 days, respectively. Infections were recorded in 43 of 187 patients (23.0%) and SSIs specifically documented in 16 patients (8.6%). Open fractures were not associated with SSI (8/83, 9.6% vs. 8/104, 7.7%). There was no difference in admission BG or HGI and infection. However, there was a significant difference in HGI when considering SSI alone (2.1 ± 1.7 vs. 1.2 ± 1.1). Patients with an SSI received a greater amount of blood transfusions (14.9 ± 12.1 vs. 4.9 ± 7.6). No patient was diagnosed with a separate infection (ie, pneumonia, UTI, bacteremia) before SSI. There was no significant difference in injury severity score among patients with an SSI (11.1 ± 4.0 vs. 9.6 ± 3.0). Multivariable regression testing with HGI as a continuous variable demonstrated a significant relationship (odds ratio: 1.8, 95% confidence interval: 1.3-2.5) with SSI after adjusting for blood transfusions (odds ratio: 1.1, 95% confidence interval: 1.1-1.2).
  
  
  CONCLUSIONS
  : Stress-induced hyperglycemia demonstrated a significant independent association with SSIs in nondiabetic orthopedic trauma patients who were admitted to the ICU.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopedic Trauma, Vanderbilt Orthopedic Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Richards
authors.forename: Rondi M
authors.initials: RM
authors.lastname: Kauffmann
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
mesh_terms: D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000209:etiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013312:Stress, Physiological; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*