All patients >or= 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: