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. 2016 Sep 30;29(3):163-171.

Statistical and clinical analysis of alterations in glucose values after burns

M K Belba  1 , E Petrela  2 , A Belba  3 , V Mano  4 , G Belba  1
Affiliations

Statistical and clinical analysis of alterations in glucose values after burns

M K Belba et al. Ann Burns Fire Disasters. .

Abstract
in English, French

The purpose of this study was to evaluate independent factors (mainly critical hyperglycaemic values on admission) with an impact on outcome in burn patients (sepsis and mortality) and analyse prevalence of critical hyperglycaemia on admission and during burn disease in adult and elderly patients with severe burns. This was an observational retrospective cohort study involving burn patients (≥ 20 years old) hospitalized in the ICU of the Burn Facility in Albania during 2010-2014. Patients were categorized as having euglycaemia, moderate or critical hyperglycaemia. Regression analysis, hyperglycaemia prediction test and risk measurement were performed for the population. Statistical significance for SIH was only found for glucose values on admission, presence of diabetes and BMI. Using 180 mg/dl as cut off for critical hyperglycaemia, we found that this test had a sensitivity of 66.67% (95% CI: 44.68% to 84.33%), specificity of 88.20% (95% CI: 84.16% to 91.51%), PPV of 29.63% (95% CI: 17.99% to 43.61%) and NPV of 97.26% (95% CI: 94.67% to 98.81%). Statistical significance was found for patients with critical hyperglycaemia on admission regarding relative and absolute risk measures for sepsis and mortality. Glucose values on admission, as one of the derangement features of burn shock, are prognostic factors in critical hyperglycaemia during disease, and have a close relationship with other outcomes (sepsis and mortality).

L’objet de cette étude est l’analyse des facteurs indépendants (essentiellement l’hyperglycémie à l’admission) ayant un impact sur le devenir des patients (sepsis et mortalité) ainsi que l’étude de la prévalence de l’hyperglycémie à l’entrée comme en cours d’hospitalisation chez des patients adultes (avec un sous-groupe de patients âgés) sévèrement brûlés. Il s’agit d’une étude rétrospective concernant des patients de plus de 20 ans hospitalisés dans lez service de réanimation pour brûlés albanais entre 2010 et 2014. Trois catégories de patients ont été définies: glycémie normale, modérément élevée, fortement élevée. Une analyse par régression a été effectuée pour évaluer la corrélation entre le devenir du patient et ses glycémies. Une corrélation avec l’hyperglycémie de stress a été trouvée en cas de glycémie élevée à l’admission, en cas de diabète et avec l’IMC. Un seuil de 180 mg/dL pour la définition d’une glycémie fortement élevée permet d’obtenir une sensibilité de 66,67% (IC95 44,68-84,33%), une spécificité de 88,2% (IC95 84,16-91,51%), une valeur prédictive positive de 29,63% (IC95 17,99-43,61) et une valeur prédictive négative de 97,26% (IC95 94,67-98,81%). Il existe une association statistiquement significative entre l’hyperglycémie à l’entrée et la morbi-mortalité. Une hyperglycémie initiale est un facteur pronostic défavorable, en termes de complications infectieuses et de moralité, chez les patients gravement brûlés.

Keywords: SIH; burns; hyperglycaemia; sepsis.

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Figures

Table I
Table I. Demographic and clinical characteristics of adult and elderly patients with severe burns
Table II
Table II. Burn related and clinical characteristics of adult and elderly patients with severe burns
Fig. 1
Fig. 1. Burn related and clinical characteristics of adult and elderly patients with severe burns
Table III
Table III. Relative and absolute risk measures for sepsis and mortality: - {with critical hyperglycaemia on admission (n=54)} - {without critical hyperglycaemia on admission (n=292)}
Fig. 2
Fig. 2. Burn related and clinical characteristics of adult and elderly patients with severe burns
Fig. 3
Fig. 3. Burn related and clinical characteristics of adult and elderly patients with severe burns
Table IV
Table IV. Characteristics of adults with critical hyperglycaemia during disease treated with insulin
See this image and copyright information in PMC

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