title: Glucose variability is an independent predictor of mortality in hospitalized patients treated with total parenteral nutrition.
abstract: OBJECTIVE
  Hyperglycemia is associated with increased mortality in critically ill patients treated with total parenteral nutrition (TPN). The role of glucose variability (GV) in predicting outcomes in these patients is not known.
  
  
  METHODS
  This retrospective study included medical and surgical patients receiving TPN in a community teaching hospital. GV was calculated by standard deviation (SD) of blood glucose (BG) values and by mean BG daily (Δ) change (daily max - daily minimum).
  
  
  RESULTS
  A total of 276 medical and surgical patients (mean age: 51 ± 18 years), 19% with a history of diabetes mellitus (DM), and 74% with intensive care unit (ICU) admission were treated with TPN. During TPN, the mean daily BG was 142.9 ± 33 mg/dL; frequencies of hypoglycemia < 70 and < 40 mg/dL were 41% and 3%, respectively; and hospital mortality was 27.2%. The mean GV by SD was 38 ± 21 mg/dL and by mean (D) change 58 ± 34 mg/dL. GV was significantly higher in deceased patients (SD: 48 ± 25 vs. 34 ± 18 mg/dL and Δ change: 75 ± 39 vs. 51 ± 29 mg/dL, both P < .01) than surviving patients. Multivariate analysis adjusted for age, DM status, gender, APACHE (Acute Physiology and Chronic Health Evaluation) score, mean daily glucose, and hypoglycemia revealed that GV was an independent predictor of hospital mortality (P < .05). The association between GV and mortality was limited to patients without a history of DM and was not present in patients with DM.
  
  
  CONCLUSIONS
  High GV is associated with increased hospital mortality independent of the presence and severity of hyperglycemia or hypoglycemia during TPN therapy. Prospective randomized trials are needed to determine if reduction in GV with intensive glycemic control improves clinical outcomes in patients treated with TPN.
authors.affiliation: Department of Medicine, Emory University School of Medicine.
authors.forename: Farnoosh
authors.initials: F
authors.lastname: Farrokhi
authors.affiliation: Department of Medicine, Emory University School of Medicine.
authors.forename: Prakash
authors.initials: P
authors.lastname: Chandra
authors.affiliation: Department of Medicine, Emory University School of Medicine.
authors.forename: Dawn
authors.initials: D
authors.lastname: Smiley
authors.affiliation: Department of Medicine, Emory University School of Medicine.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Pasquel
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Limin
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of Medicine, Emory University School of Medicine.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Newton
authors.affiliation: Department of Medicine, Emory University School of Medicine.
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose