Hyperglycemia Is Associated With Adverse Outcomes in Patients Receiving Total Parenteral Nutrition

Abstract

OBJECTIVE -Hyperglycemia is associated with poor clinical outcomes and mortality in myocardial infarction, stroke, and general hospital patients. However, there are few data regarding the effect of hyperglycemia on outcomes in patients receiving total parenteral nutrition (TPN), a therapy that predisposes patients to hyperglycemia. The aim of this study was to determine whether elevated blood glucose levels are associated with adverse outcomes in patients receiving TPN. RESEARCH DESIGN AND METHODS-A retrospective analysis was undertaken from the medical records of 111 patients (122 treatment episodes) receiving TPN. All patients had blood drawn daily for the measurement of blood glucose levels. Outcome measures were assessed as a function of mean daily blood glucose levels while receiving TPN.RESULTS -Increased blood glucose levels were associated with an increased risk of cardiac complications (odds ratio 1.61, 95% CI 1.09 -2.37, P ϭ 0.02), infection (1.4, 1.08 -1.82, P ϭ 0.01), systemic sepsis (1.36, 1.00 -1.86, P ϭ 0.05), acute renal failure (1.47, 1.00 -2.17, P ϭ 0.05), and death (1.77, 1.23-2.52, P Ͻ 0.01). When the data were examined by quartiles of blood glucose levels, the mortality of subjects in the highest quartile was 10.9 times (95% CI 2.0 -60.5, P Ͻ 0.01) that of subjects in the lowest quartile, and the risk of developing any complication was 4.3 times higher (1.4 -13.1, P Ͻ 0.01). These effects were independent of age, sex, or prior diabetes status.CONCLUSIONS -Hyperglycemia is a predictor of poor outcomes in patients receiving TPN. The confirmation of a relation between blood glucose levels and adverse outcomes provides support for tight glycemic control in these patients. Diabetes Care 28:2367-2371, 2005H yperglycemia is associated with adverse outcomes in critically ill patients. A number of studies have demonstrated a relation between blood glucose levels and mortality after myocardial infarction (1) and stroke (2). Among hospitalized patients in general, those with hyperglycemia have a higher mortality rate than those with normal glucose levels (3). Hyperglycemia has been associated with increased infection rates in patients after cardiothoracic (4 -6) or general (7) surgery. Recent randomized controlled trials in intensive care settings (8) and myocardial infarction (9) have also demonstrated that glucose control with insulin therapy can reduce mortality.One group of patients who should be particularly susceptible to hyperglycemia are those who require total parenteral nutrition (TPN). These patients are often critically ill and are administered preparations with a high glucose content. The combination of these two factors leads to a high frequency of hyperglycemia in a particularly vulnerable population. Central vein catheter infections have been observed to be five times more prevalent in diabetic patients than in the general TPN population (10). However, to date, the potential for hyperglycemia to result in other adverse outcomes in patients receiving TPN has not been systematically exami...

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