Document Detail


Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients.
MedLine Citation:
PMID:  20881765     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE(S): To evaluate whether acute glucose elevation (AGE) is predictive of infection and outcome in critically injured trauma patients during the first 14 days of ICU admission. METHODS: A prospective study was conducted on 2200 patients admitted to the ICU over a 2 1/2 year period. The diagnosis of infection was made via a multidisciplinary fashion utilizing CDC criteria. After early glucose stabilization occurred (no significant change for 48 hours after admission) monitoring for AGE was performed utilizing a computational and graded algorithmic model. Iatrogenic causes of AGE were excluded. Stepwise regression models were performed controlling for age, gender, mechanism of injury, diabetes, injury severity, and APACHE 2 score. ROC curves were used to evaluate the positive predictive value of the test. RESULTS: Seventy-seven percent of the patients in the cohort were males, and were admitted for blunt injuries (n = 1870 or 85%). The mean age, Injury Severity Score, and APACHE score were 44 ± 20 years, 29 ± 13, and 13 ± 7, respectively. The mean admission serum glucose value was 141 ± 36 mg/dL (range, 64-418 mg/dL). A total of 616 (28%) patients were diagnosed with an infection during the first 14 days of admission. AGE had a 91% positive predictive value for infection diagnosis. In addition, AGE was associated with a significant increase in ventilator, ICU, and hospital days as well as mortality even when adjusted for age, injury severity, APACHE score, and diabetes (P < 0.001). CONCLUSIONS: AGE is a highly accurate predictor of infection and should stimulate clinicians to identify a new source of infection.
Authors:
Grant V Bochicchio; Kelly M Bochicchio; Manjari Joshi; Obeid Ilahi; Thomas M Scalea
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  252     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2010-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  597-602     Citation Subset:  AIM; IM    
Affiliation:
Division of Clinical and Outcomes Research, Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. gbochicchio@umm.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Algorithms
Blood Glucose / analysis*
Critical Illness
Female
Humans
Infection / blood*
Male
Prognosis
Prospective Studies
Wound Infection / blood*,  diagnosis
Wounds and Injuries / blood*
Chemical
Reg. No./Substance:
0/Blood Glucose

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