Most Infectious Complications in Parenterally Fed Trauma Patients Are Not Due to Elevated Blood Glucose Levels

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Abstract
Objective: To determine the relationship between hyperglycemia and infectious complications in nutritional studies of trauma patients. Methods: Retrospective review of serum glucose values in two published randomized, prospective studies of patients receiving either enteral or parenteral feeding (trial 1) or isonitrogenous, isocaloric enteral diets (trial 2). Trial 2 also included patients prospectively followed who received little or no enteral feeding. Results: Patients randomized to enteral or parenteral feeding in trial 1 exhibited no significant differences in the highest recorded serum glucose (SG) until the fourth or fifth day after protocol entry. SG tended to be higher in infected than noninfected patients in the first 4 hospital days, but SG was far below values considered to increase the risk for infection (SG > 220 mg/dL). In trial 2, glucose levels tended to be slightly higher in infected than in noninfected patients within the first 5 days reaching statistical significance by day 5. Unfed control patients had similar SG values but significantly more major infectious complications. Conclusions: Patients developing infections had slightly higher SG levels than noninfected patients early in admission, but these SG values were far below levels considered a risk for infective complications. Significant hyperglycemia does not explain differences in infectious complications in critically ill trauma patients randomized to various routes and types of nutrition. (Journal of Parenteral and Enteral Nutrition 25:174-179, 2001)