Association of Hyperglycemia with Increased Mortality after Severe Burn Injury

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Abstract
Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury. Survey of the medical records from January 1996 to July 1999 identified 58 pediatric patients with burns ≥ 60% body surface. Patients were categorized as having poor glucose control (n = 33) if ≥ 40% of all plasma glucose determinations were ≥ 7.8 mmol/L (140 mg/dL) and compared with patients deemed to have adequate glucose control (n = 25) in whom ≤ 40% of all glucose values were ≥ 7.8 mmol/L. Despite similar age, burn size, caloric intake, and frequency of wound infection, patients categorized with poor glucose control had a significantly greater incidence of positive blood cultures (positive blood cultures/length of stay days, 0.42 ± 0.04 for hyperglycemia patients vs. 0.30 ± 0.03 for normoglycemia patients; mean ± SEM, p ≤ 0.05). This finding was especially prominent for blood cultures positive for yeast. Hyperglycemia patients had significantly less percentage of skin graft take than did the normoglycemic patients (percent take/operative procedure, 64 ± 9 for hyperglycemia patients vs. 88 ± 5 for normoglycemia patients;p < 0.05). Nine patients (27%) with persistent hyperglycemia died compared with only one death (4%) in patients with adequate glucose control (p ≤ 0.05). This association between poor glucose control, bacteremia/fungemia, reduced skin graft take, and subsequent mortality in severely burned children may be related to a hyperglycemia-induced detriment in antimicrobial defense. Although this report fails to establish cause and effect, these findings suggest that aggressive maneuvers to normalize plasma glucose in critically injured patients may be warranted.