Objective : The purpose of this study was to assess the utility of two levels of hyperglycemia as predictors for mortality and infectious morbidity in traumatically injured patients.
Methods : All patients ≥ 17 years old presenting to a Level I trauma center as a trauma alert or a trauma code from January 1, 2000, through December 31, 2000, were reviewed. Hypoglycemic patients (glucose concentration < 70 mg/dL) were excluded (n = 4). Patients were considered hyperglycemic with an admission glucose concentration > 200 mg/dL (moderate hyperglycemia) or an admission glucose concentration in the upper quartile for the group (mild hyperglycemia [glucose concentration > 135 mg/dL]).
Results : Seven hundred thirty-eight patients were included in the study. Hyperglycemia was associated with increased mortality among both patients with moderate hyperglycemia (34.1% vs. 3.7%, p < 0.01) and those with mild hyperglycemia (15.5% vs. 2%, p < 0.01) compared with corresponding normoglycemic groups. Hyperglycemia proved to be an independent predictor of mortality and of hospital and intensive care unit length of stay after multiple logistic regression while controlling for age, Injury Severity Score, Revised Trauma Score, and gender. Infectious complications, including pneumonia (9.4% vs. 2%, p = 0.001), urinary tract infections (6.6% vs. 1.4%, p = 0.001), wound infections (4.9% vs. 0.6%, p = 0.039), and bacteremia (5% vs. 1.1%, p = 0.004), were significantly increased in patients with elevated glucose concentrations. Hyperglycemia is an independent predictor of increased infectious morbidity controlling for age, gender, and Injury Severity Score in multiple logistic regression models.
Conclusion : 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).
S imilar injuries lead to remarkably different outcomes in similar populations. Specific individuals seem to respond to the stressful situation of trauma differently; some are discharged after a relatively uneventful hospital course, whereas others develop a complicated course, with a few dying as a result of their injury. For this reason, several models have been developed to predict outcome after injury. Most of these models use physiologic and/or anatomic information to predict outcome. 1,2 Laboratory tests used as markers of such adverse outcomes include base deficit, serum lactate, serum glucose, transferrin, C-reactive protein, albumin, and cholesterol. 3 Several studies have demonstrated the association between glucose concentrations and outcome in both head trauma and nontrauma situations. 4-6 Few studies have looked at this association within the trauma population not restricted to head trauma. Clinically significant hyperglycemia has traditionally been defined as a serum glucose concentration > 200 mg/dL. 7-9 However, studies have demonstrated associations of hyperglycemia far below this level with adverse outcomes, 6 encouraging a search for lower cutoffs. The association between hyperglycemia and increased infectious morbidity has an established biologic and clinical basis. 9-12 In this study, we investigate the usefulness of admission serum glucose as a prognostic variable and its relationship to patient outcome and infectious morbidity in patients with traumatic injuries.