title: Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit.
abstract: OBJECTIVE
  Although large studies have demonstrated the association between hyperglycemia and adverse intensive care unit (ICU) outcomes, it is yet unclear which subset of patients benefit from tight sugar control in ICU. Recent evidence suggests that stress induced hyperglycemia (SIH) and co-incidentally detected diabetes mellitus are different phenomena with different prognoses. Differentiating SIH from diabetic hyperglycemia is challenging in ICU settings. We followed a cohort of trauma patients admitted to a surgical intensive care unit (SICU) to evaluate if initial glycated hemoglobin A (HbA1c) level predicts the outcome of admission.
  
  
  METHODS
  A cohort of 120 consecutive admissions to SICU following trauma were recruited and admission blood sugar and HbA1c were measured. Outcomes were prospectively measured by blinded ICU doctors. A logistic regression model was developed to assess if HbA1c predicts poor outcomes in these settings.
  
  
  RESULTS
  Nearly 24% of the participants had HbA1c ≥ 6. Those with HbA1c ≥ 6 had 3.14 times greater risk of poor outcome at the end of hospital stay when compared to those with HbA1c < 6 and this risk increased to an odds ratio of 4.57 on adjusting for other significant predictors: Acute Physiology and Chronic Health Evaluation II, injury severity score, admission blood sugar and age at admission.
  
  
  CONCLUSIONS
  Substantial proportion of trauma admissions has underlying diabetes. HbA1c, a measure of pre admission glycaemic status is an important predictor of ICU outcome in trauma patients.
authors.affiliation: Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Karen Ruby
authors.initials: KR
authors.lastname: Lionel
authors.affiliation: Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Jacob
authors.initials: J
authors.lastname: John
authors.affiliation: Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Nagamani
authors.initials: N
authors.lastname: Sen
keywords: Diabetes mellitus; glycosylated hemoglobin A; intensive care; stress induced hyperglycemia; trauma