Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition

OBJECTIVE - Hyperglycemia is associated with poor clinical outcomes and mortality in myocardial infarction, stroke, and general hospital patients. However, there are few data regarding the effect of hyperglycemia on outcomes in patients receiving total parenteral nutrition (TPN), a therapy that predisposes patients to hyperglycemia. The aim of this study was to determine whether elevated blood glucose.levels are associated with adverse outcomes in patients receiving TPN. RESEARCH DESIGN AND METHODS - A retrospective analysis was undertaken from the medical records of 111 patients (122 treatment episodes) receiving TPN. All patients had blood drawn daily for the measurement of blood glucose levels. Outcome measures were assessed as a function of mean daily blood glucose levels while receiving TPN. RESULTS - increased blood glucose levels were associated with an increased risk of cardiac complications (odds ratio 1.61, 95% CI 1.09-2.37, P = 0.02), infection (1.4, 1.08-1.82, P = 0.01), systemic sepsis (1.36, 1.00-1.86, P = 0.05), acute renal failure (1.47, 1.00-2,17, P = 0.05), and death (1.77, 1.23-2.52, P < 0.01). When the data were examined by quartiles of blood glucose levels, the mortality of subjects in the highest quartile was 10.9 times (951/0 CI 2.0-60.5, P < 0.01) that of subjects in the lowest quartile, and the risk of developing any complicationwas 4.3 times higher (1.4-13.1, P < 0.01). These effects were independent of age, sex, or prior diabetes status. CONCLUSIONS - Hyperglycernia is a predictor of poor outcomes in patients receiving TPN. The confirmation of a relation between blood glucose levels and adverse outcomes provides support for tight glycemic control in these patients.