Admission Hyperglycemia Predicts Infectious Complications After Burns

Abstract

Inflammation and hypermetabolism post burn predisposes to hyperglycemia and insulin resistance. The authors hypothesize that admission hyperglycemia predicts infectious outcomes. A retrospective review of all patients greater than 20 years of age admitted for initial burn management from January 2008 to December 2013 was conducted. Nonthermal injuries, transfers, and those without admission glucose or histories were excluded. Hyperglycemia was defined as admission glucose ≥150 mg/dl. Patients were grouped as follows: euglycemic without diabetes (control), euglycemic with diabetes (-H+D), hyperglycemic without diabetes (+H-D), and hyperglycemic with diabetes (+H+D). Outcomes included infection, mortality, length of stay, and disposition. Comparisons were made using Fisher's exact test and multiple logistic regression. A total of 411 patients were analyzed. No significant differences between any of the groups and controls were noted in race, inhalation injury, or obesity. All three groups had higher mortality compared with controls. Longer hospital stays were noted only in +H-D. +H-D and +H+D were less likely to be discharged home than controls. +H-D had higher rates of bacteremia, +H-D and +H+D had higher rates of pneumonia, and -H+D and +H-D had higher rates of urinary tract infection. Regression for infection and mortality outcomes with TBSA, age, diabetes, hyperglycemia, obesity, race, gender, and inhalation injury as covariates was performed. Hyperglycemia was the only independent predictor of bacteremia (area under curve [AUC] = 0.736). Hyperglycemia was also a predictor of pneumonia and urinary tract infection (AUC = 0.766 and 0.802, respectively). The only independent predictors of mortality were age, TBSA, and inhalation injury (AUC = 0.892). Acute glucose dysregulation may be more important than diabetes in predicting infectious outcomes after burns. Therefore, admission glucose may have prognostic value.

Type 2 diabetes mellitus and risk of community-acquired pneumonia: a systematic review and meta-analysis of observational studies

“…Characteristics of the included studies are described in Table 1. Fifteen articles 3,5,6,8,10,[12][13][14][15][16]18 reporting on 13 cohort studies and 4 case-control studies 7,9,18,19 were included. The article by Seminog and Goldacre 10 reported results from 3 distinct cohorts (Linked English Hospital Episodes Statis tics [LHES], Oxford Record Linkage Study 1 [ORLS1] and Oxford Record Linkage Study 2 [ORLS2]) that were non overlapping, and thus we analyzed results from each of these cohorts separately but considered them collectively when describing study characteristics.…”

“…Six studies defined exposure as type 2 diabetes specifically, 3,6-9,15 while 9 studies considered diabetes in general. 5,10,12,13,16 The exposure and outcome assessment varied among studies (Appendix 1, Supplemental Table S2). Most studies adjusted for age, sex and socioeconomic status in their fully adjusted models.…”

“…The combined risk of bias for all studies was serious, as all studies presented a serious risk of bias in at least 1 of the ROBINSI domains (Appendix 1, Supplemental Table S3). Four, 7 and 4 studies were at low, 7,12,13,15 moderate 5,8,10,14,16,18,19 and serious risk 3,6,9,17 of selection bias, respectively. All studies were either at low 3,5,[7][8][9][10]12,[15][16][17]19 or moderate 6,13,14,18 risk of exposure misclassification (classification of intervention in ROBINSI).…”

The clinically used PARP inhibitor olaparib improves organ function, suppresses inflammatory responses and accelerates wound healing in a murine model of third‐degree burn injury

“…In light of the fact that hyperglycaemia is a common pathophysiological event in burns, which precedes and predicts many of the subsequent adverse events (Gauglitz et al, 2008;Mecott et al, 2010;Finnerty et al, 2014;Jeschke et al, 2016;Ray et al, 2016), it was interesting to note that olaparib attenuated the burn-associated early hyperglycaemia in our current model. We interpret this finding as an indication that the overall stress response and/or the acute insulin resistance that develops in burns may be, at least in part, dependent on PARP.…”

Incidence of Hypoglycemia in Burn Patients: A Focus for Process Improvement

“…1,5,7 Additional evidence exists on the timing of attaining adequate glycemic control in burn patients with early control resulting in reductions in infectious complications and improved mortality. 5,8 The purpose of this study is to assess and characterize the glycemic control of critically ill burn patients at our institution and to determine whether further action needs to be taken to better manage continuous insulin infusions (CII) in these patients. received a CII.…”