Parenteral nutrition-associated hyperglycemia in non-critically ill inpatients increases the risk of in-hospital mortality (multicenter study).
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Olveira Gabriel, Tapia María José, Ocón Julia, Cabrejas-Gómez Carmen, Ballesteros-Pomar María D, Vidal-Casariego Alfonso, Arraiza-Irigoyen Carmen, Olivares Josefina, Conde-García Maria Del Carmen, García-Manzanares Alvaro, Botella-Romero Francisco, Quílez-Toboso Rosa P, Cabrerizo Lucio, Matia Pilar, Chicharro Luisa, Burgos Rosa, Pujante Pedro, Ferrer Mercedes, Zugasti Ana, Prieto Javier, Diéguez Marta, Carrera María José, Vila-Bundo Anna, Urgelés Juan Ramón, Aragón-Valera Carmen, Rovira Adela, Bretón Irene, García-Peris Pilar, Muñoz-Garach Araceli, Márquez Efren, Del Olmo Dolores, Pereira José Luis, Tous María C, Study Group of Hyperglycemia in Parenteral Nutrition: Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN)
Аннотация
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.