Admission Hyperglycemia and its Implications on Outcome in Patients Attending Medical Intensive Care Units at Assiut University Hospital

Abstract

Background: Admission hyperglycemia is defined as any blood glucose (BG) level greater than 140 mg/dL (>7.8 mmol/L) in critical care unit (CCU) according to American Diabetes Association 2015. Stress hyperglycemia is related to multiple factors and can lead to insulin resistance and high hepatic glucose output. Aim: To determine the frequency, in-hospital mortality, and length of stay in a cohort of patients with admission hyperglycemia in unselected acute medically ill patients admitted to medical intensive care units (ICUs) (medical ICU and CCU) attending Internal Medicine Department, Assiut University Hospital, Assiut, Egypt, and to evaluate whether admission hyperglycemia or other comorbid conditions are responsible for outcome of critical ill patients. Subjects and Methods: This prospective, observational study involved 170 patients admitted at ICU unit of Internal Medicine Department at Assiut University Hospital between July and December 2016. Measurement of BG on admission to ICU was as following: normoglycemic if less than 140 mg/dL and hyperglycemic if more than 140 mg/dL. Then, follow up BG every 8h till either discharge or death or maximum 4 days in addition to fasting, postprandial BG, HbA1C, complete blood count and kidney function tests, serum sodium, serum potassium, arterial blood gases, and acute physiologic assessment and chronic health score were carried out. Results: This study included 170 patients, 35.3% were normoglycemic and 64.7% were hyperglycemic, which were further subdivided into 43% known diabetics, 14.1% stress hyperglycemia, and 7.6% newly discovered diabetics. Percentage of survivors was 72.9% versus non-survivors, which was 27.1%. Median hospital stay for all patients was 6 (4–28) days with in-hospital mortality of 46 (27.1%) patients. It was noticed that frequency of non-survivors was higher in patients with hyperglycemic versus that of survivors. Conclusion: Stress hyperglycemia and diabetes were independent predictors for in-hospital mortality in patients with admission hyperglycemia attending ICU.

Association Between Glycemic Gap and Mortality in Critically Ill Patients with Diabetes

“…23 It makes researchers turn to the relationship between the degree of premorbid glycaemia and mortality, the admission blood glucose levels are especially proved associated with higher mortality. 24 Researchers had concluded that admission hyperglycemia could result from a combination of acute physiological stress or higher baseline blood glucose. 25 Quantification of the level of chronic glycemia in critically ill patients provides important clinical information how severity critical illness-associated dysglycemia is.…”

Effect of glycemic gap upon mortality in critically ill patients with diabetes

“…Fawzy 29 reported that the elevated glycemic gap between the admission blood glucose and the previous glycemic level was associated with an increased ICU mortality, and the predictive power for the mortality of critically ill patients was improved effectively with the APACHE II score incorporated 30 . Meanwhile, the stress hyperglycemia ratio, that is, the fasting glucose concentration at admission divided by the ADAG, confirmed by Fabbri et al 31,32 , was predictive of mortality following admission for sepsis, and it may be used to refine the prediction of an unfavorable outcome.…”