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. 2010 Jul;24(7):453-7.
doi: 10.1155/2010/718526.

Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality

Sofia Sarkisian  1 , Tanis R Fenton, Abdel Aziz Shaheen, Maitreyi Raman
Affiliations

Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality

Sofia Sarkisian et al. Can J Gastroenterol. 2010 Jul.

Abstract
in English, French

Background: Hyperglycemia is a marker of poor clinical outcomes in studies evaluating hospitalized critically ill patients.

Objectives: To identify whether glycemic control is associated with health outcomes including acute coronary events, renal failure, infection, hospital length of stay, intensive care unit (ICU) admission, sepsis and mortality in noncritically ill patients administered parenteral nutrition (PN), and to compare the current standard of care for glucose monitoring at the Foothills Medical Centre (Calgary, Alberta) with the 2009 American Society of Parenteral and Enteral Nutrition guidelines.

Methods: A retrospective chart review of 100 adult (18 years of age or older) non-ICU inpatients who received PN for seven days or longer at the Foothills Medical Centre was conducted.

Results: Seventeen patients (17%) had a mean blood glucose level of 10.0 mmol/L or greater. PN patients with a mean blood glucose level of 10 mmol/L or greater had a higher rate of mortality than patients with a mean blood glucose level of less than 10 mmol/L (OR 7.22; 95% CI 1.08 to 48.29; P=0.042). Hyperglycemia was independently and significantly associated with mortality when adjusted for age and sex. Acute coronary events, renal failure, infection, hospital length of stay, ventilator use and ICU admissions were not associated with hyperglycemia. Only one-half of those with hyperglycemia, and none of the patients in the euglycemic group, received adequate glucose monitoring during the first two days of PN.

Conclusion: Hyperglycemia in noncritically ill inpatients receiving PN was found to be a risk factor for increased mortality.

HISTORIQUE :: L’hyperglycémie est un marqueur de mauvaises issues cliniques dans des études évaluant des patients hospitalisés gravement malades.

OBJECTIFS :: Déterminer si le contrôle de la glycémie s’associe à des issues de santé, y compris les événements coronariens aigus, l’insuffisance rénale, l’infection, la durée d’hospitalisation, l’admission aux soins intensifs (SI), la sepsie et la mortalité chez des patients sous alimentation parentérale (AP), et comparer la norme actuelle de surveillance de la glycémie au Foothills Medical Centre (de Calgary, en Alberta) avec les lignes directrices 2009 de l’American Society of Parenteral and Enteral Nutrition.

MÉTHODOLOGIE :: Les chercheurs ont procédé à l’examen rétrospectif du dossier de 100 patients hospitalisés (d’au moins 18 ans) qui n’étaient pas aux soins intensifs et qui ont été sous AP pendant au moins sept jours au Foothills Medical Centre.

RÉSULTATS :: Dix-sept patients (17 %) avaient une glycémie moyenne d’au moins 10,0 mmol/L. Les patients sous AP dont la glycémie moyenne était d’au moins 10 mmol/L présentaient un taux de mortalité plus élevé que ceux dont la glycémie était de 10 mmol/L ou moins (RRR 7,22; 95 % IC 1,08 à 48,29; P=0,042). L’hyperglycémie s’associait de manière indépendante et significative à la mortalité après rajustement compte tenu de l’âge et du sexe. Les événements coronariens aigus, l’insuffisance rénale, l’infection, la durée d’hospitalisation, le recours au respirateur et les admissions aux SI n’étaient pas liés à l’hyperglycémie. Seulement la moitié des patients hyperglycémiques, et aucun de ceux faisant partie du groupe euglycémique, ont reçu une surveillance pertinente de leur glycémie pendant les deux premiers jours d’AP.

CONCLUSION :: Les chercheurs ont déterminé que l’hyperglycémie était un facteur de risque de mortalité accrue chez les patients sous AP qui n’étaient pas gravement maladies

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Figures

Figure 1)
Figure 1)
Indications for parenteral nutrition. Gastrointestinal includes ileus, Crohn’s disease, ulcerative colitis, fistula, upper/lower gastorintestinal bleed, perforated esophagus, celiac disease, radiation enteritis and necrotizing fasciitis. Other indications include surgeon preference to protect anastamosis and avoid feeding tube placement
Figure 2)
Figure 2)
Mortality rates according to mean glucose levels
Figure 3)
Figure 3)
Number of glucose measurements taken in the first 48 h according to hyperglycemia occurrence
Figure 4)
Figure 4)
Number of glucose measurements taken in days 3 through 9 according to hyperglycemia occurrence
See this image and copyright information in PMC

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