Hyperglycemia upon onset of nosocomial bloodstream infection adversely affects outcome in a mixed intensive care unit population
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KeywordsHyperglycemia Blood Glucose Level Antibiotic Resistance Antimicrobial Therapy Observational Cohort Study
Hyperglycemia in critically ill patients is frequently related to a hypermetabolic stress-response and has been associated with increased morbidity and mortality. The aim of this study was to assess the relationship between blood glucose levels and clinical outcome in a mixed cohort of critically ill patients with a nosocomial bloodstream infection (BSI).
A retrospective observational cohort study was conducted including 130 adult patients with a microbiologically documented BSI admitted over a 2-year period (2003–2004) to the ICU. Blood glucose levels were evaluated from 1 day prior to onset of BSI (d-1) until 5 days after onset of BSI (d+5). The contribution of hyperglycemia, divided into three subgroups (≥150 mg/dl, ≥175 mg/dl, and ≥200 mg/dl, respectively), to inhospital mortality was estimated by logistic regression.
The mean age of the study population was 54.7 ± 19.0 years. Inhospital mortality was 36.2%. Hyperglycemia (≥175 mg/dl and ≥200 mg/dl) was observed more often among the non-survivors. Over the seven study days, no differences were found in daily morning blood glucose levels between survivors (n = 83) and nonsurvivors (n = 47) (all P > 0.05). Although in the nonsurvivors the evolution of glycemia tended to be higher, this trend was not statistically significant compared with the survivors. Multivariate logistic regression revealed that age (P = 0.022), APACHE II score (P = 0.003), antibiotic resistance (P = 0.001), and hyperglycemia (≥ 200 mg/dl) upon onset of BSI (P = 0.001) were independently associated with inhospital mortality, whereas appropriate antimicrobial therapy ≤24 hours (P = 0.016) and previous history of diabetes (P = 0.022) were associated with better outcome.
Trends of blood glucose levels were higher among nonsurvivors. Hyperglycemia (≥200 mg/dl) upon onset of nosocomial BSI adversely affects outcome in a heterogeneous ICU population.