Persistent Hyperglycemia is Predictive of Outcome in Critically Ill Trauma Patients

OBJECTIVES: There is a paucity of data evaluating whether hyperglycemia at admission is associated with adverse outcome in trauma patients. Our objectives were to determine whether admission hyperglycemia was predictive of outcome in critically ill trauma patients. METHODS: Prospective data were collected daily on 1,003 consecutive trauma patients admitted to the intensive care unit over a 2-year period. Diabetics were excluded. Patients were stratified by admission serum glucose level ( or =200 mg/dL) age, gender, Injury Severity Score, and other preexisting risk factors. Outcome was measured by incidence of infection, ventilator days, hospital length of stay and intensive care unit length of stay, and mortality. Multiple linear regression models were used to determine level of significance. RESULTS: Two hundred fifty-five of 1,003 (25%) patients were admitted with hyperglycemia over the study period. The majority (78%) of the admissions were caused by blunt injury. Male patients accounted for the majority of the study population (73%); however, female patients were more likely to be hyperglycemic at admission (p = 0.015). Patients with hyperglycemia had an overall greater infection rate and hospital length of stay. The hyperglycemic group had a 2.2-times greater risk of mortality when adjusted for age and Injury Severity Score. CONCLUSION: Hyperglycemia at admission is an independent predictor of outcome and infection in trauma patients. Future investigation on the effects of hyperglycemia are warranted.