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Characterization of persistent hyperglycemia: what does it mean postinjury?
Jason L Sperry1, Heidi L Frankel, Avery B Nathens
1Division of Trauma and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. sperryjl@upmc.edu
The Journal of Trauma
|April 11, 2009
Summary
Strict glycemic control in trauma patients is vital. Maintaining blood glucose below 145 mg/dL improves survival and reduces mortality, even with persistent hyperglycemia.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Endocrinology
Background:
- Strict glycemic control reduces morbidity and mortality in critically ill surgical patients.
- Overly aggressive hyperglycemia management can have adverse effects.
- This study examines outcomes of persistent hyperglycemia (PH) in trauma patients under a strict glycemic control protocol.
Purpose of the Study:
- To characterize clinical outcomes associated with different levels of persistent hyperglycemia (PH) in severely injured trauma patients.
- To evaluate the impact of PH on mortality and nosocomial infection (NI) under a strict glycemic control protocol.
- To identify specific glucose thresholds associated with poor outcomes.
Main Methods:
- A multicenter prospective cohort study of adult trauma patients with hemorrhagic shock.
- Glycemic control analyzed by average maximum daily glucose from postinjury day 2 to day 5.
- Persistent hyperglycemia defined as mean glucose >130 mg/dL, categorized into three severity levels.
- Cox proportional hazard regression used to assess association of PH with mortality and NI.
Main Results:
- Overall mortality was 10.8%; NI rate was 49.6%.
- Persistent hyperglycemia (>145 mg/dL and >165 mg/dL) was independently associated with significantly higher mortality.
- PH was not independently associated with increased NI, but was linked to higher early multiple organ failure incidence.
Conclusions:
- Maintaining daily maximum glucose values <145 mg/dL is associated with a survival benefit in trauma patients.
- Persistent hyperglycemia, despite insulin therapy, increases multiple organ failure and mortality risk.
- The strict protocol may have prevented infectious complications, underscoring the importance of glycemic control in trauma.
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