Admission Hyperglycemia as a Prognostic Indicator in Trauma

Abstract

Hyperglycemia independently predicts increased intensive care unit and hospital length of stay and mortality in the trauma population. It is associated with increased infectious morbidity. These associations hold true for mild hyperglycemia (glucose concentration > 135 mg/dL) and moderate hyperglycemia (glucose concentration > 200 mg/dL).

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

“…This was associated with greater in-hospital mortality, longer hospital stays, and increased rates of admission to the ICU. Additionally, the general trauma and critical care literature is replete with investigations on the relationship of hyperglycemia with morbidity and mortality following critical illness [9][10][11][12]15,16 , with some authors suggesting that ongoing persistent hyperglycemia and subsequent glucose control are predictive of outcome 21,24 . However, this has not been easily translated into results that may be applied in an environment outside of an ICU.…”

“…Recent investigations suggest that a stress-induced hyperglycemic response following substantial trauma is strongly correlated with clinical outcome, even after consideration of age and injury severity [14][15][16] . Hyperglycemia was associated with an increased risk of infectious complications in nondiabetic orthopaedic trauma patients 17 .…”

Pulmonary Infectious Diseases in Association with Diabetes Mellitus

“…Furthermore, those patients with newlydiagnosed hyperglycemia frequently had longer hospital stay and intensive care unit (ICU) admission [4]. Various associated adverse outcomes in patients with hyperglycemia was revealed, such as ischemic or hemorrhagic stroke [8], acute myocardial infarction [9], trauma [10], and surgery [11]. An increase in blood glucose concentration of 1 mmol/liter is associated with a 3% increase in the risk of in-hospital complications [12].…”

Evaluation of Effectiveness and Safety of an ICU Insulin Infusion Protocol

“…There is clear evidence that hyperglycemia is correlated with poor clinical outcomes and glycemic control confers better prognosis. [1][2][3][4][5][6][7][8] The recommended strategy for glycemic control among the critically-ill is intravenous insulin adjusted based on a standardized protocol. The American Diabetes Association (ADA) recommends that insulin infusion protocols (IIP) be standardized in an institution.…”