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Early Hyperglycemia Predicts Multiple Organ Failure and Mortality but Not Infection

Sperry, Jason L. MD, MPH; Frankel, Heidi L. MD; Vanek, Sue L. RN; Nathens, Avery B. MD, PhD, MPH; Moore, Ernest E. MD; Maier, Ronald V. MD; Minei, Jospeh P. MD

The Journal of Trauma: Injury, Infection, and Critical Care: September 2007 - Volume 63 - Issue 3 - p 487-494
doi: 10.1097/TA.0b013e31812e51fc
Original Articles
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Background: Previous studies attempting to characterize the association between early hyperglycemia (EH) and subsequent outcome have been performed without utilization of a strict glycemic control protocol. We sought to characterize the clinical outcomes associated with EH in a cohort of severely injured trauma patients, when a strict glycemic control protocol was used.

Methods: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Known diabetics and patients with isolated traumatic brain injury were excluded from the analysis. A strict glycemic protocol (target glucose, 80–110 mg/dL) was employed. Cox proportional hazard regression was used to evaluate the effects of EH on multiple organ failure (MOF), nosocomial infection (NI), and mortality, after adjusting for the effects of early death on subsequent infection rates.

Results: Overall mortality, MOF, and NI rates for the entire cohort were 19.6%, 37.5%, and 42.2%, respectively, with a mean Injury Severity Score of 31.6 ± 14. Cox proportional hazard regression confirmed that EH was independently associated with almost a twofold higher mortality rate and a 30% higher incidence of MOF, but was not an independent risk factor for NI, after controlling for all important confounders. There continued to be no independent association between EH and NI, even when stratified by infection type (pneumonia, catheter-related blood stream infection, or urinary tract infection).

Conclusion: These results suggest that EH is a marker of severe physiologic insult after injury, and that strict glycemic control may reduce or prevent the infectious complications previously shown to be associated with hyperglycemia early after injury.

From the Division of Burn, Trauma, Critical Care (J.L.S., H.L.F., S.L.V., J.P.M.), University of Texas Southwestern Medical Center, Dallas, Texas; Division of General Surgery and Trauma, St. Michael’s Hospital and Department of Surgery (A.B.N.), University of Toronto, Toronto, Ontario, Canada; Department of Surgery (E.E.M.), Denver Health Medical Center and The University of Colorado Health Sciences Center, Denver, Colorado; and Division of General Surgery and Trauma, Harborview Medical Center and the Department of Surgery (R.V.M.), University of Washington, Seattle, Washington.

Submitted for publication December 8, 2006.

Accepted for publication May 29, 2007.

Supported by the National Institutes of Health (NIH NIGMS U54 GM062119-1).

Presented at the 20th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 16–20, 2007, Fort Meyers, Florida.

Address for reprints: Joseph P. Minei, MD, Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Stop 9158, Dallas, TX 75390-9158; email: joseph.minei@utsouthwestern.edu.

© 2007 Lippincott Williams & Wilkins, Inc.