Association of hyperglycemia with increased mortality after severe burn injury

Dennis Gore, D. Chinkes, J. Heggers, David Herndon, Steven Wolf, M. Desai

Research output: Contribution to journalArticle

349 Citations (Scopus)

Abstract

Background: Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury. Methods: Survey of the medical records from January 1996 to July 1999 identified 58 pediatric patients with burns ≥ 60% body surface. Patients were categorized as having poor glucose control (n = 33) if ≥ 40% of all plasma glucose determinations were ≥ 7.8 mmol/L (140 mg/dL) and compared with patients deemed to have adequate glucose control (n = 25) in whom ≤ 40% of all glucose values were ≥ 7.8 mmol/L. Results: Despite similar age, burn size, caloric intake, and frequency of wound infection, patients categorized with poor glucose control had a significantly greater incidence of positive blood cultures (positive blood cultures/length of stay days, 0.42 ± 0.04 for hyperglycemia patients vs. 0.30 ± 0.03 for normoglycemia patients; mean ± SEM, p ≤ 0.05). This finding was especially prominent for blood cultures positive for yeast. Hyperglycemia patients had significantly less percentage of skin graft take than did the normoglycemic patients (percent take/operative procedure, 64 ± 9 for hyperglycemia patients vs. 88 ± 5 for normoglycemia patients; p < 0.05). Nine patients (27%) with persistent hyperglycemia died compared with only one death (4%) in patients with adequate glucose control (p ≤ 0.05). Conclusion: This association between poor glucose control, bacteremia/fungemia, reduced skin graft take, and subsequent mortality in severely burned children may be related to a hyperglycemia-induced detriment in antimicrobial defense. Although this report fails to establish cause and effect, these findings suggest that aggressive maneuvers to normalize plasma glucose in critically injured patients may be warranted.

Original languageEnglish (US)
Pages (from-to)540-544
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number3
StatePublished - 2001

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Hyperglycemia
Mortality
Wounds and Injuries
Glucose
Fungemia
Transplants
Skin
Operative Surgical Procedures
Wound Infection
Bacteremia
Energy Intake
Burns
Wound Healing
Medical Records
Immunity
Length of Stay
Yeasts
Pediatrics

ASJC Scopus subject areas

  • Surgery

Cite this

Association of hyperglycemia with increased mortality after severe burn injury. / Gore, Dennis; Chinkes, D.; Heggers, J.; Herndon, David; Wolf, Steven; Desai, M.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 51, No. 3, 2001, p. 540-544.

Research output: Contribution to journalArticle

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abstract = "Background: Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury. Methods: Survey of the medical records from January 1996 to July 1999 identified 58 pediatric patients with burns ≥ 60{\%} body surface. Patients were categorized as having poor glucose control (n = 33) if ≥ 40{\%} of all plasma glucose determinations were ≥ 7.8 mmol/L (140 mg/dL) and compared with patients deemed to have adequate glucose control (n = 25) in whom ≤ 40{\%} of all glucose values were ≥ 7.8 mmol/L. Results: Despite similar age, burn size, caloric intake, and frequency of wound infection, patients categorized with poor glucose control had a significantly greater incidence of positive blood cultures (positive blood cultures/length of stay days, 0.42 ± 0.04 for hyperglycemia patients vs. 0.30 ± 0.03 for normoglycemia patients; mean ± SEM, p ≤ 0.05). This finding was especially prominent for blood cultures positive for yeast. Hyperglycemia patients had significantly less percentage of skin graft take than did the normoglycemic patients (percent take/operative procedure, 64 ± 9 for hyperglycemia patients vs. 88 ± 5 for normoglycemia patients; p < 0.05). Nine patients (27{\%}) with persistent hyperglycemia died compared with only one death (4{\%}) in patients with adequate glucose control (p ≤ 0.05). Conclusion: This association between poor glucose control, bacteremia/fungemia, reduced skin graft take, and subsequent mortality in severely burned children may be related to a hyperglycemia-induced detriment in antimicrobial defense. Although this report fails to establish cause and effect, these findings suggest that aggressive maneuvers to normalize plasma glucose in critically injured patients may be warranted.",
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AU - Heggers, J.

AU - Herndon, David

AU - Wolf, Steven

AU - Desai, M.

PY - 2001

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N2 - Background: Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury. Methods: Survey of the medical records from January 1996 to July 1999 identified 58 pediatric patients with burns ≥ 60% body surface. Patients were categorized as having poor glucose control (n = 33) if ≥ 40% of all plasma glucose determinations were ≥ 7.8 mmol/L (140 mg/dL) and compared with patients deemed to have adequate glucose control (n = 25) in whom ≤ 40% of all glucose values were ≥ 7.8 mmol/L. Results: Despite similar age, burn size, caloric intake, and frequency of wound infection, patients categorized with poor glucose control had a significantly greater incidence of positive blood cultures (positive blood cultures/length of stay days, 0.42 ± 0.04 for hyperglycemia patients vs. 0.30 ± 0.03 for normoglycemia patients; mean ± SEM, p ≤ 0.05). This finding was especially prominent for blood cultures positive for yeast. Hyperglycemia patients had significantly less percentage of skin graft take than did the normoglycemic patients (percent take/operative procedure, 64 ± 9 for hyperglycemia patients vs. 88 ± 5 for normoglycemia patients; p < 0.05). Nine patients (27%) with persistent hyperglycemia died compared with only one death (4%) in patients with adequate glucose control (p ≤ 0.05). Conclusion: This association between poor glucose control, bacteremia/fungemia, reduced skin graft take, and subsequent mortality in severely burned children may be related to a hyperglycemia-induced detriment in antimicrobial defense. Although this report fails to establish cause and effect, these findings suggest that aggressive maneuvers to normalize plasma glucose in critically injured patients may be warranted.

AB - Background: Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury. Methods: Survey of the medical records from January 1996 to July 1999 identified 58 pediatric patients with burns ≥ 60% body surface. Patients were categorized as having poor glucose control (n = 33) if ≥ 40% of all plasma glucose determinations were ≥ 7.8 mmol/L (140 mg/dL) and compared with patients deemed to have adequate glucose control (n = 25) in whom ≤ 40% of all glucose values were ≥ 7.8 mmol/L. Results: Despite similar age, burn size, caloric intake, and frequency of wound infection, patients categorized with poor glucose control had a significantly greater incidence of positive blood cultures (positive blood cultures/length of stay days, 0.42 ± 0.04 for hyperglycemia patients vs. 0.30 ± 0.03 for normoglycemia patients; mean ± SEM, p ≤ 0.05). This finding was especially prominent for blood cultures positive for yeast. Hyperglycemia patients had significantly less percentage of skin graft take than did the normoglycemic patients (percent take/operative procedure, 64 ± 9 for hyperglycemia patients vs. 88 ± 5 for normoglycemia patients; p < 0.05). Nine patients (27%) with persistent hyperglycemia died compared with only one death (4%) in patients with adequate glucose control (p ≤ 0.05). Conclusion: This association between poor glucose control, bacteremia/fungemia, reduced skin graft take, and subsequent mortality in severely burned children may be related to a hyperglycemia-induced detriment in antimicrobial defense. Although this report fails to establish cause and effect, these findings suggest that aggressive maneuvers to normalize plasma glucose in critically injured patients may be warranted.

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