Background and aims
Hyperglycemia, a major side effect of patients receiving total parenteral nutrition (PN), is associated with higher mortality in critically ill patients. The aim of this study was to determine whether elevated blood glucose levels would be associated with worse outcomes in patients receiving PN.
Methods
This retrospective study included postoperative patients admitted to our surgical intensive care unit (SICU) from July 2008 to June 2009. Data collected included blood glucose levels, length of stay, and outcome measures. Correlations among daily average, maximum, and minimum blood glucose levels and outcome measures were calculated.
Results
Sixty-nine patients were enrolled and divided into PN (n?=?40) and non-PN (n?=?29) groups. The?initial mean blood glucose levels were 138.4?¡À?63.1?mg/dL and 123.2?¡À?41.8?mg/dL for the PN and non-PN groups, respectively. The mean blood glucose concentration was significantly increased (¦¤BS?=?44.8?¡À?57.3?mg/dL; p?<?0.001) in the PN group compared with the non-PN group (¦¤BS?=?39.4?¡À?67.0?mg/dL; p?=?0.004). The blood glucose concentration was significantly increased and consequently, consumption of insulin was increased on the 2nd day of ICU admission. The risk of mortality increased by a factor of 1.3 (OR?=?1.30, 95 % CI?=?1.07-1.59, p?=?0.010) for each 10?mg/dL increase in blood glucose level, when the daily maximum blood glucose level was >250?mg/dL. There were no cases of mortality in the current study when the blood glucose levels were controlled below 180?mg/dL. The mean blood glucose level in patients receiving PN was higher in those with diabetes than in those without diabetes (215.5?¡À?42.8 vs. 165.8?¡À?42.0?mg/dL, respectively, p?=?0.001).
Conclusion
The blood glucose level was associated with patient outcome and should be intensively monitored in critically ill surgical patients. We suggest that blood glucose levels should be controlled below 180?mg/dL in postoperative critically ill patients.
