Hyperglycemia in Critically Ill Patients: Management and Prognosis.
BACKGROUND
Hyperglycemia is a common complication of critical illness. Patients in intensive care unit with stress hyperglycemia have significantly higher mortality (31%) compared to patients with previously confirmed diabetes (10%) or normoglycemia (11.3%). Stress hyperglycemia is associated with increased risk of critical illness polyneuropathy (CIP) and prolonged mechanical ventilation. Intensive monitoring and insulin therapy according to the protocol are an important part of the treatment of critically ill patients.


OBJECTIVE
To evaluate the incidence of stress hyperglycemia, complications and outcome in critically ill patients in our Medical intensive care unit.


METHODS
This study included 100 patients hospitalized in Medical intensive care unit during the period January 2014-March 2015 which were divided into three groups: Diabetes mellitus, stress-hyperglycemia and normoglycemia. During the retrospective-prospective observational clinical investigation the following data was obtained: age, gender, SAPS, admission diagnosis, average daily blood glucose, highest blood glucose level, glycemic variability, vasopressor and corticosteroid therapy, days on mechanical ventilation, total days of hospitalization in Medical intensive care unit, and outcome.


RESULTS
Patients with DM treated with a continuous insulin infusion did not have significantly more complications than patients with normoglycemia, unlike patients with stress hyperglycemia, which had more severe prognosis. There was a significant difference between the maximum level of blood glucose in recovered and patients with adverse outcome (p = 0.0277). Glycemic variability (difference between max. and min. blood glucose) was the strongest predictor of adverse outcome. The difference in glycemic variability between the stress-hyperglycemia and normoglycemic group was statistically significant (p = 0.0066). There was no statistically significant difference in duration of mechanical ventilation and total days of hospitalization in the intensive care unit between the groups.


CONCLUSIONS
Understanding of the objectives of glucose regulation and effective glycemic control is essential for the proper optimization of patient outcomes.
Medical Intensive Care Unit, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Amina
A
Godinjak
Medical Intensive Care Unit, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Amer
A
Iglica
Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Azra
A
Burekovic
Medical Intensive Care Unit, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Selma
S
Jusufovic
Medical Intensive Care Unit, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Anes
A
Ajanovic
Medical Intensive Care Unit, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Ira
I
Tancica
Medical Intensive Care Unit, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Adis
A
Kukuljac
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000628:therapy*; D048909:Diabetes Complications / Q000628:therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
D007328:Insulin
critical illness; hyperglycemia