Hyperglycemia During Total Parenteral Nutrition

Abstract

OBJECTIVE To determine the effect of total parenteral nutrition (TPN)-induced hyperglycemia on hospital outcome. RESEARCH DESIGN AND METHODS The study determined whether blood glucose values before, within 24 h, and during days 2–10 of TPN are predictive of hospital complications and mortality. RESULTS Subjects included a total of 276 patients receiving TPN for a mean duration of 15 ± 24 days (±SD). In multiple regression models adjusted for age, sex, and diabetes status, mortality was independently predicted by pre-TPN blood glucose of 121–150 mg/dl (odds ratio [OR] 2.2, 95% CI 1.1–4.4, P = 0.030), 151–180 mg/dl (3.41, 1.3–8.7, P = 0.01), and >180 mg/dl (2.2, 0.9–5.2, P = 0.077) and by blood glucose within 24 h of >180 mg/dl (2.8, 1.2–6.8, P = 0.020). A blood glucose within 24 h of >180 mg/dl was associated with increased risk of pneumonia (OR 3.1, 95% CI 1.4–7.1) and acute renal failure (2.3, 1.1–5.0). CONCLUSIONS Hyperglycemia is associated with increased hospital complications and mortality in patients receiving TPN.