Time and degree of glycemic derangement are associated with increased mortality in trauma patients in the setting of tight glycemic control.

BACKGROUND Tight glucose control (TGC) may reduce mortality in critically ill trauma patients. We hypothesize that euglycemia is beneficial, and a measure considering time and degree of hyperglycemia is most associated with mortality. METHODS We performed a review of intensive care unit trauma patients admitted for more than 3 days between January 2005 and December 2007 on a TGC protocol with a goal of 80 to 110 mg/dL. Hyperglycemic, hypoglycemic, and euglycemic time ranges, and area of interpolated curves above and below 80 to 110 mg/dL were assessed. Associations with mortality were based on logistic regression models adjusted for age, injury severity score, and admission Glasgow Coma Scale score. RESULTS A total of 546 patients were identified, and 68 (13%) died. Time spent as hyperglycemic (P = .29) and hyperglycemic area under the curve (P = .58) were not associated with mortality; hyperglycemic area/time (P = .01) was associated with mortality. Regarding hypoglycemia, area over the curve (P = .009) and time spent as hypoglycemic (P = .002) were associated with mortality. CONCLUSIONS TGC prevents prolonged, high degrees of hyperglycemia; avoiding hypoglycemia likely provides mortality benefit for trauma patients.