Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients.

Abstract

OBJECTIVE(S):

To evaluate whether acute glucose elevation (AGE) is predictive of infection and outcome in critically injured trauma patients during the first 14 days of ICU admission.

METHODS:

A prospective study was conducted on 2200 patients admitted to the ICU over a 2 1/2 year period. The diagnosis of infection was made via a multidisciplinary fashion utilizing CDC criteria. After early glucose stabilization occurred (no significant change for 48 hours after admission) monitoring for AGE was performed utilizing a computational and graded algorithmic model. Iatrogenic causes of AGE were excluded. Stepwise regression models were performed controlling for age, gender, mechanism of injury, diabetes, injury severity, and APACHE 2 score. ROC curves were used to evaluate the positive predictive value of the test.

RESULTS:

Seventy-seven percent of the patients in the cohort were males, and were admitted for blunt injuries (n = 1870 or 85%). The mean age, Injury Severity Score, and APACHE score were 44 ± 20 years, 29 ± 13, and 13 ± 7, respectively. The mean admission serum glucose value was 141 ± 36 mg/dL (range, 64-418 mg/dL). A total of 616 (28%) patients were diagnosed with an infection during the first 14 days of admission. AGE had a 91% positive predictive value for infection diagnosis. In addition, AGE was associated with a significant increase in ventilator, ICU, and hospital days as well as mortality even when adjusted for age, injury severity, APACHE score, and diabetes (P < 0.001).

CONCLUSIONS:

AGE is a highly accurate predictor of infection and should stimulate clinicians to identify a new source of infection.

• Authors: Grant V Bochicchio, Kelly M Bochicchio, Manjari Joshi, Obeid Ilahi, Thomas M Scalea
• Journal: Annals of surgery (Ann Surg) Vol. 252 Issue 4 Pg. 597-602 (Oct 2010) ISSN: 1528-1140 [Electronic] United States
• PMID: 20881765 (Publication Type: Journal Article)

Chemical References

• Blood Glucose

Topics

• APACHE
• Adult
• Algorithms
• Blood Glucose (analysis)
• Critical Illness
• Female
• Humans
• Infections (blood)
• Male
• Prognosis
• Prospective Studies
• Wound Infection (blood, diagnosis)
• Wounds and Injuries (blood)