Abstract
BackgroundStress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed.MethodsWe conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness.ResultsThe search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.DiscussionSHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.
Highlights
The identified studies were heterogeneous in study conduct, Stress-related hyperglycaemia (SHG) definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting
Hyperglycaemia is frequently observed in critically ill patients [1] and can occur in the absence of pre-existing glucose intolerance or diabetes mellitus
Reduced morbidity and mortality were observed in surgical intensive care units (ICUs) patients whose target Blood glucose (BG) levels were 80–110 mg/dL (4.4–6.1 mmol/L) [4].Subsequently, other interventional trials were unable to reproduce the results of the pioneering trial [15,16,17,18,19,20,21]; for example, the NICE-SUGAR study found that a target BG level of
Summary
Hyperglycaemia is frequently observed in critically ill patients [1] and can occur in the absence of pre-existing glucose intolerance or diabetes mellitus. There is a lack of external validation of the target BG levels observed in previous trials and no widely accepted SHG definition. This is both a result of heterogeneous patient characteristics and management and divergence in individual study design, including BG target, type of BG measurement, outcome variable (e.g. 28-, 90-, or 180-day mortality, or ICU or hospital mortality), setting, and available resources [24]. Stress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Populations, and outcome measures used in observational studies were analysed
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