Hyperglycemia During Total Parenteral Nutrition

An important marker of poor outcome and mortality in hospitalized patients

Pasquel, Francisco J. MD
Spiegelman, Ronnie PHD
McCauley, Megan MD
Smiley, Dawn MD
Umpierrez, Denise BA
Johnson, Rachel BA
Rhee, Mary MD
Gatcliffe, Chelsea BA
Lin, Erica BA
Umpierrez, Erica
Peng, Limin PHD
Umpierrez, Guillermo E. MD

¹Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;
²Rollins School of Public Health, Emory University, Atlanta, Georgia.

Corresponding author: Guillermo Umpierrez, [email protected].

Received September 18, 2009

Accepted December 21, 2009

Diabetes Care 33(4):p 739-741, April 2010. | DOI: 10.2337/dc09-1748

OBJECTIVE

To determine the effect of total parenteral nutrition (TPN)-induced hyperglycemia on hospital outcome.

RESEARCH DESIGN AND METHODS

The study determined whether blood glucose values before, within 24 h, and during days 2–10 of TPN are predictive of hospital complications and mortality.

RESULTS

Subjects included a total of 276 patients receiving TPN for a mean duration of 15 ± 24 days (±SD). In multiple regression models adjusted for age, sex, and diabetes status, mortality was independently predicted by pre-TPN blood glucose of 121–150 mg/dl (odds ratio [OR] 2.2, 95% CI 1.1–4.4, P = 0.030), 151–180 mg/dl (3.41, 1.3–8.7, P = 0.01), and >180 mg/dl (2.2, 0.9–5.2, P = 0.077) and by blood glucose within 24 h of >180 mg/dl (2.8, 1.2–6.8, P = 0.020). A blood glucose within 24 h of >180 mg/dl was associated with increased risk of pneumonia (OR 3.1, 95% CI 1.4–7.1) and acute renal failure (2.3, 1.1–5.0).

CONCLUSIONS

Hyperglycemia is associated with increased hospital complications and mortality in patients receiving TPN.