Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients

Abstract

Objective: To determine the effect of total parenteral nutrition (TPN)-induced hyperglycemia on hospital outcome.

Research design and methods: The study determined whether blood glucose values before, within 24 h, and during days 2-10 of TPN are predictive of hospital complications and mortality.

Results: Subjects included a total of 276 patients receiving TPN for a mean duration of 15 +/- 24 days (+/-SD). In multiple regression models adjusted for age, sex, and diabetes status, mortality was independently predicted by pre-TPN blood glucose of 121-150 mg/dl (odds ratio [OR] 2.2, 95% CI 1.1-4.4, P = 0.030), 151-180 mg/dl (3.41, 1.3-8.7, P = 0.01), and >180 mg/dl (2.2, 0.9-5.2, P = 0.077) and by blood glucose within 24 h of >180 mg/dl (2.8, 1.2-6.8, P = 0.020). A blood glucose within 24 h of >180 mg/dl was associated with increased risk of pneumonia (OR 3.1, 95% CI 1.4-7.1) and acute renal failure (2.3, 1.1-5.0).

Conclusions: Hyperglycemia is associated with increased hospital complications and mortality in patients receiving TPN.

Figure 1

Mean blood glucose (BG) levels and mortality rate. □, blood glucose levels pre-TPN (BG Pre-TPN), P = 0.167. ■, blood glucose levels within 24 hours of TPN (BG-24h TPN), P = 0.004. ■, blood glucose levels during days 2–10 of TPN (BG D2–10 of TPN), P = 0.060.