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)

  1. María C. Tous, MD20
  1. 1Endocrinology and Nutrition Service, Carlos Haya University Hospital, Málaga, Spain
  2. 2CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
  3. 3Endocrinology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
  4. 4Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, León, Spain
  5. 5Endocrinology and Nutrition Service, Complejo Hospitalario de Jaén, Jaén, Spain
  6. 6Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Illes Balears, Spain
  7. 7Endocrinology and Nutrition Service, Hospital General Mancha Centro, Ciudad-Real, Spain
  8. 8Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
  9. 9Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
  10. 10Nutritional Support Unit, University Hospital Vall d’Hebron, Barcelona, Spain
  11. 11Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
  12. 12Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Navarra, Spain
  13. 13Endocrinology and Nutrition Service, Hospital de Cabueñes, Asturias, Spain
  14. 14Endocrinology and Nutrition Service, Hospital del Mar (Barcelona), Barcelona, Spain
  15. 15Endocrinology and Nutrition Service, Hospital Universitario Son Dureta (Palma de Mallorca), Illes Balears, Spain
  16. 16Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain
  17. 17Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
  18. 18Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
  19. 19Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Madrid, Spain
  20. 20Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain
  1. 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.

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This Article

  1. Diabetes Care
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