Clinical significance and prognosis of the diverse causal hyperglycemia of critical patients

Abstract

Objective To clarify the clinical significance and prognoses of critical patients with hyperglycemia incurred by various causes. Method A total of 826 critical patients were enrolled during the period from October 2006 to November 2007, and blood sugar was measured by using rapid testing devices within the first hour after admission. If blood sugar measured was more than 11.1 mmol/L, the diagnosis of hyperglycemia was made, and furthermore, glycosylated hemoglobin (GHb) was detected as well. The diagnosis of hyperglycemia was made in 651 critical patients and those patients were followed up for 28 days to confirm the diagnosis. According to the levels of GHb, they were divided in two groups, namely normal GHb and high GHb groups. Each group was further divide into two subgroups, namely diabetes group and non -diabetes group in order to compare the fatality rate between the two groups. Results There were 385 patients diagnosed to have diabetes and among them, 155 patients had no clear history of diabetes, accounting for about 23.81% of the 651 hyperglycemia patients. There were 266 (40.86% ) patients were diagnosed to have stress induced hyperglycemia, The fatality rate of 28 - day in the high GHb group was higher than that in the normal GHb group (12. 23% vs 5. 82% , P = 0.001) . In the high GHb group, the fatality rate of 28-day in the patients without clear history of diabetes was higher than that in the patients with clear history of diabetes (19.21% vs7.11%, P =0. 000). Conclusions The hyperglycemia found in critical patients could not be all attributed to the stress induced hyperglycemia especially in the patients without clear history of diabetes, and the prognoses of patients with variously causal hyperglycemia were various. Key words: Critical patients; Glycosylated hemoglobin; Hyperglycemia; Prognosis; Stress induced hyperglycemia; Diabetes; Random glycemia