Glucose intolerance in intensive care patients: Incidence and outcome

Abstract

ABSTRACTBackground: Critical illness is associated with modification in metabolic status. Insulin resistance and elevated blood glucose levels occur during stressful conditions. We aimed to evaluate the incidence and outcome of glucose intolerance in intensive care patients.Material and methods: This prospective clinical study included 290 patients, admitted to the intensive care unit (ICU). They were divided into three groups according to the maximum blood glucose level on admission and after 48 hours of admission: Normoglycemic, hyperglycemic, and hypoglycemic. Each group was subdivided into diabetic and non-diabetic. Patients’ age, sex, APACHE II, and causes of admission were recorded. Use of vasopressor and corticosteroid therapy, type of feeding, days on mechanical ventilation, total days of stay in ICU, and fate of patients were recorded.Results: Hyperglycemia was common in critically ill patients with 68.6% and 86.2% incidence on ICU admission and after 48 hours of admission, respectively. Sixty percent of the patients were diabetic. Hyperglycemia was associated with increased morbidity in the form of difficult weaning from mechanical ventilation and long ICU stay. Of hyperglycemic patients, 66.4% were orally fed. The mortality incidence among normoglycemic patients was 37.5%; which was lower than the mortality among hyperglycemic patients (39.2%), but without a statistically significant difference. Glucose intolerance was not related to the severity of the disease or cause of admission. Vasopressors and steroids were not risking factors during the initial 48 hours of admission.Conclusion: Glucose intolerance is high in intensive care patients and is associated with high morbidity and mortality.

Keywords

• Acute Physiology and Chronic Evaluation (APACHE II) score
• intensive care unit
• glucose intolerance
• diabetes mellitus (DM)