Hyperglycemia has a stronger relation with outcome in trauma patients than in other critically ill patients

Mathijs Vogelzang, Johanna M M Nijboer, Iwan C C van der Horst, Felix Zijlstra, Henk Jan ten Duis, Maarten W N Nijsten
Journal of Trauma 2006, 60 (4): 873-7; discussion 878-9

BACKGROUND: Acute hyperglycemia is associated with adverse outcome in critically ill patients. Glucose control with insulin improves outcome in surgical intensive care unit (SICU) patients, but the effect in trauma patients is unknown. We investigated hyperglycemia and outcome in SICU patients with and without trauma.

METHODS: A 12-year retrospective study was performed at a 12-bed SICU. We collected the reason for admission, Injury Severity Scores (ISS), and 30-day mortality rates. Glucose measurements were used to calculate the hyperglycemic index (HGI), a measure indicative of overall hyperglycemia during the entire SICU stay.

RESULTS: In all, 5234 nontrauma and 865 trauma patients were studied. Trauma patients were younger, more frequently male, and had both lower median admission glucose (123 versus 133 mg/dL) and HGI levels (8.9 vs. 18.4 mg/dL) than nontrauma patients (p < 0.001). Mortality was 12% in both groups. Area under the receiver-operator characteristic for HGI and mortality was 0.76 for trauma patients and 0.58 for nontrauma patients (p < 0.001). In multivariate analysis, HGI correlated better with mortality in trauma patients than in nontrauma patients (p < 0.001). Head-injury and nonhead-injury trauma patients showed similar glucose levels and relation between glucose and mortality.

CONCLUSIONS: The relation of hyperglycemia and mortality is more pronounced in trauma patients than in SICU patients admitted for other reasons. The different behavior of hyperglycemia in these patients underscores the need for evaluation of intensive insulin therapy in these patients.

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