Parenteral Nutrition-Associated Hyperglycemia in Noncritically Ill Inpatients Increases the Risk of In-hospital Mortality (Multicenter Study)
Study Group of Hyperglycemia in Parenteral Nutrition: Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN)
- Gabriel Olveira, PHD1,2⇓,
- María José Tapia, MD1,
- Julia Ocón, PHD3,
- Carmen Cabrejas-Gómez, MD3,
- María D. Ballesteros-Pomar, PHD4,
- Alfonso Vidal-Casariego, MD4,
- Carmen Arraiza-Irigoyen, MD5,
- Josefina Olivares, MD6,
- Maria del Carmen Conde-García, PHD7,
- Álvaro García-Manzanares, MD7,
- Francisco Botella-Romero, PHD8,
- Rosa P. Quílez-Toboso, MD8,
- Lucio Cabrerizo, PHD9,
- Pilar Matia, MD9,
- Luisa Chicharro, MD10,
- Rosa Burgos, PHD10,
- Pedro Pujante, MD11,
- Mercedes Ferrer, PHD11,
- Ana Zugasti, PHD12,
- Javier Prieto, MD13,
- Marta Diéguez, MD13,
- María José Carrera, MD14,
- Anna Vila-Bundo, MD14,
- Juan Ramón Urgelés, MD15,
- Carmen Aragón-Valera, MD16,
- Adela Rovira, PHD16,
- Irene Bretón, MD17,
- Pilar García-Peris, PHD17,
- Araceli Muñoz-Garach, MD18,
- Efren Márquez, PHD18,
- Dolores del Olmo, PHD19,
- José Luis Pereira, MD20 and
- María C. Tous, MD20
- 1Endocrinology and Nutrition Service, Carlos Haya University Hospital, Málaga, Spain
- 2CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
- 3Endocrinology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- 4Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, León, Spain
- 5Endocrinology and Nutrition Service, Complejo Hospitalario de Jaén, Jaén, Spain
- 6Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Illes Balears, Spain
- 7Endocrinology and Nutrition Service, Hospital General Mancha Centro, Ciudad-Real, Spain
- 8Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- 9Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
- 10Nutritional Support Unit, University Hospital Vall d’Hebron, Barcelona, Spain
- 11Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- 12Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Navarra, Spain
- 13Endocrinology and Nutrition Service, Hospital de Cabueñes, Asturias, Spain
- 14Endocrinology and Nutrition Service, Hospital del Mar (Barcelona), Barcelona, Spain
- 15Endocrinology and Nutrition Service, Hospital Universitario Son Dureta (Palma de Mallorca), Illes Balears, Spain
- 16Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain
- 17Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
- 18Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
- 19Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Madrid, Spain
- 20Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain
- Corresponding author: Gabriel Olveira, gabrielm.olveira.sspa{at}juntadeandalucia.es
Abstract
OBJECTIVE Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients.
RESEARCH DESIGN AND METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality.
RESULTS The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels <140 mg/dL (95% CI 1.47–21.4 mg/dL) after adjusting for age, sex, nutritional state, presence of diabetes or hyperglycemia before starting TPN, diagnosis, prior comorbidity, carbohydrates infused, use of steroid therapy, SD of blood glucose level, insulin units supplied, infectious complications, albumin, C-reactive protein, and HbA1c levels.
CONCLUSIONS Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.
- Received July 11, 2012.
- Accepted October 2, 2012.
- © 2012 by the American Diabetes Association.
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