Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality

BACKGROUND:

Hyperglycemia is a marker of poor clinical outcomes in studies evaluating hospitalized critically ill patients.

OBJECTIVES:

To identify whether glycemic control is associated with health outcomes including acute coronary events, renal failure, infection, hospital length of stay, intensive care unit (ICU) admission, sepsis and mortality in noncritically ill patients administered parenteral nutrition (PN), and to compare the current standard of care for glucose monitoring at the Foothills Medical Centre (Calgary, Alberta) with the 2009 American Society of Parenteral and Enteral Nutrition guidelines.

METHODS:

A retrospective chart review of 100 adult (18 years of age or older) non-ICU inpatients who received PN for seven days or longer at the Foothills Medical Centre was conducted.

RESULTS:

Seventeen patients (17%) had a mean blood glucose level of 10.0 mmol/L or greater. PN patients with a mean blood glucose level of 10 mmol/L or greater had a higher rate of mortality than patients with a mean blood glucose level of less than 10 mmol/L (OR 7.22; 95% CI 1.08 to 48.29; P=0.042). Hyperglycemia was independently and significantly associated with mortality when adjusted for age and sex. Acute coronary events, renal failure, infection, hospital length of stay, ventilator use and ICU admissions were not associated with hyperglycemia. Only one-half of those with hyperglycemia, and none of the patients in the euglycemic group, received adequate glucose monitoring during the first two days of PN.

CONCLUSION:

Hyperglycemia in noncritically ill inpatients receiving PN was found to be a risk factor for increased mortality.