hyperglycemia in C
hyperglycemia in Critically ill Medical patients (Single center study)
Osama A. Khalil, Monkez M. Yuossef, Magda M. Sherif, Alsayed Alnahall and Ghonium M.E.
Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
Abstract: Stress hyperglycemia is common in critically ill patients, even without a history of diabetes. It has been recently recognized to be associated with increased mortality and morbidity. Therefore this study was designed to assess the prevalence of stress hyperglycemia in Medical Intensive Care Subunits of Zagazig University Hospitals and to study why some individuals develop stress hyperglycemia and others will not in similar clinical and metabolic circumstances by estimation of relative risk of some risk factors (age, BMI, SBP, +ve family history of DM and APACHE II score of severity), and lastly to predict the clinical outcome of stress hyperglycaemic patients in medical ICU. Patients and methods This cross sectional observational prospective study included747 subjects admitted in medical ICU Subunits in period of six months, 224 of these patients were admitted to cardio-pulmonary subunit, 137 patients were admitted to stroke subunit, 258 patients were admitted to general subunit, and 128 patients were admitted to hepato gastroenterology subunit. the included subjects were subdivided to three groups according to FBG, RBG, and HbA1c, as follow: Group I (Normoglycemic group included 408 patients,Group II( Non diabetic stress hyperglycaemic group included 136 patients with no history of diabetes on admission. Group III (Diabetic group included 203 patients. All subjects of this study were subjected to full history, through physical examination and Routine investigations which include(Complete blood picture, Liver and Kidney function tests, Arterial blood gases,RBG. FBG, HbA1c and ICU severity was assessed by APACHE II score. Results We found that the patients with stress hyperglycemia were (18.21%) and the diabetic patients were (54.61%) while the normglycemic patients were (27.17%). And the highest frequency of patients developed stress hyperglycemia was observed in cardio-pulmonary subunit (25%), followed by stroke subunit (21.8%), and the lowest frequency was in both general and gastroenterology and hepatology subunits (13.5%, 11.71% respectively.) and the presence of +ve family history of diabetes, age > 50 years, BMI > 25kg /m2,SBP >130mmHg, and APACHE II score > 16 increase the relative risk of occurrence of stress hyperglycemia by 3.37, 2.05, 2.42, 3.43, 2.5 fold respectively. The results revealed that the mean duration of ICU stay for patients with stress hyperglycemia was significantly increased (6.64 ± 4.80 days) compared to diabetics (6.34±6.34days) and normoglycemic patients (5.01±3.09days) and the patients with stress hyperglycemia had lower improvement rates at the time of discharge (49.26%) compared to diabetics (65.02%), and normglycemic patients(67.15%) and patients with stress hyperglycemia were more complicated at the time of discharge (11.76%) than diabetics (6.40%) and normoglycemic(5.88%). In addition, the mean mortality rate for the patients with stress hyperglycemia was (38.97%) compared to diabetics (28.57%) and normoglycemic (26.56%) subjects. ConclusionWe can conclude that the stress hyperglycemia is significantly prevalent in medical ICU of Zagazig University Hospitals with highest figures among patients with cardiovascular and cerebrovascular emergencies. Also there are many risk factors that may increasing the risk of occurrence of stress hyperglycemia in stressful conditions more than others the most risky one was positive family history followed by increased systolic blood pressure,BMI,then age and finally stress hyperglycemia in ICU worsen the APACHEII score and increase the mortality and duration of hospital stay. Therefore strict control of stress hyperglycemia is recommended to decrease mortality and hospital stay in ICU.
[Osama A. Khalil, Monkez M. Yuossef, Magda M. Sherif, Alsayed Alnahall and Ghonium M.E. Epidemiology and clinical outcome of ICU-acquired Stress hyperglycemia in Critically ill Medical patients (Single center study. J Am Sci 2013;9(6):406-413]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 49
Key words: American Diabetic Association (ADA), Random blood glucose (RBG), Fasting blood glucose(FBG),APACHE II score: Acute Physiology And Chronic Health Evaluation, Intensive care unit(ICU), Free fatty acids(FFAs). Full Text 49