Observation and Outcome on Stress Hyperglycemia Among Non-diabetic Patients Admitted in Medical ICU

INTRODUCTION: Acute hyperglycemia, among non-diabetic critically ill in intensive care (ICU), is a physiological marker of a stress response.(1) According to various studies, people with hyperglycemia who have never been diagnosed with diabetes have poorer outcomes at a given level of hyperglycemia than those who have diabetes.(2–4) But most of these study has done in surgical field, so we have tried to look after the situation in critically ill medical patients. OBJECTIVES: To find out incidence of hyperglycemia in non-diabetic patients admitted in medical ICU. To observe the outcome of hyperglycaemia in non-diabetic patients in terms of mortality and length of ICU stay and compare those outcome between hyperglycaemic and normoglycemic non diabetic patients. MATERIALS AND METHODS: This hospital based prospective, observational study was conducted over 18 months with 234 non-diabetics patients. Management of hyperglycemia (capillary blood sugar >180 mg/dL) was done as per hospital protocol. All cases were followed for consecutive 7 days at least unless patient was shifted out or died. Patients were divided into two groups based on their initial glycemic status (blood sugar >180 mg/dL and <180 mg/dL). APACHE II score and SOFA (Sequential organ Failure Assessment) score were applied to all patients included in the study to adjust and assess for severity and prognosis respectively. Appropriate statistical tools followed by logistic regression to assess the effect of hyperglycaemia on mortality and other factors was applied. RESULTS: 1. 40 (17.1%) patients had hyperglycemia in our study. So incidence of stress hyperglycemia among nondiabetics in medical ICU of our hospital is 17.1%. 2. 11 (27.5%) patients with hyperglycemia and 9 (4.6%) patients without hyperglycemia died in our study. It was observed that significantly higher number of patients with hyperglycemia died compared to patients without hyperglycemia as per Chi-Square test (27.5% vs. 4.6%; p<0.05). 3. The mean number of days of ICU stay of patients with and without hyperglycemia was 9.98 ± 4.14 days and 4.98 ± 1.97 days respectively with mean number of overall days of ICU stay at ICU was 5.84 days with standard deviation of 3.1days. The patients with hyperglycemia had significantly longer ICU stay as per Student t-test (p<0.05). DISCUSSIONS/CONCLUSIONS: The incidence of stress hyperglycemia is high in critically ill patients even among non-diabetics in medical ICU. Mortality was higher in patients with stress hyperglycemia and so is long ICU stay. These hyperglycaemic patients are may have higher risk for development new infection, need of ventilator support. These patients should be followed up in terms of the development of permanent diabetes mellitus.