Aims: We explore the infection incidence and possible prognostic outcome relevance for patients with different blood glucose levels in an intensive care unit (ICU). Methods: A total of 98 cases were enrolled and divided into three groups based on average fasting blood glucose levels (group A: ≤6.1 mmol/l; group B: 6.1-10 mmol/l; group C: ≥10 mmol/l). Results: There were no statistical differences in the time to ICU admission, the indwelling durations of gastric tubes, urinary or deep vein catheters, tracheal intubations and tracheotomies, or the length of ventilator use (all p > 0.05). No evident difference in the multiple organ dysfunction syndrome rate was found between the three groups (p = 0.226). The infection and mortality rates between the groups showed significant differences (all p < 0.05). Furthermore, the difference of respiratory system infections was statistically significant among the three groups (p = 0.008), yet no such statistical difference was observed among groups regarding nonrespiratory system infections (p = 0.227). Conclusions: Critically ill patients with a high blood glucose level were positively correlated with a relatively high APACHE II score and more serious degree of disease, as well as a higher incidence of respiratory infection during their ICU stay than those with lower blood glucose levels (<10 mmol/l).

1.
Barsanti MC, Woeltje KF: Infection prevention in the intensive care unit. Infect Dis Clin North Am 2009;23:703-725.
[PubMed]
2.
Barzilai N, Huffman DM, Muzumdar RH, Bartke A: The critical role of metabolic pathways in aging. Diabetes 2012;61:1315-1322.
[PubMed]
3.
Blot F, Similowski T, Trouillet JL, Chardon P, Korach JM, Costa MA, Journois D, Thiery G, Fartoukh M, Pipien I, Bruder N, Orlikowski D, Tankere F, Durand-Zaleski I, Auboyer C, Nitenberg G, Holzapfel L, Tenaillon A, Chastre J, Laplanche A: Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill icu patients. Intensive Care Med 2008;34:1779-1787.
[PubMed]
4.
Bornfeldt KE, Tabas I: Insulin resistance, hyperglycemia, and atherosclerosis. Cell Metab 2011;14:575-585.
[PubMed]
5.
Bosch AA, Biesbroek G, Trzcinski K, Sanders EA, Bogaert D: Viral and bacterial interactions in the upper respiratory tract. PLoS Pathogens 2013;9:e1003057.
[PubMed]
6.
Chakrabarti B, Angus RM, Agarwal S, Lane S, Calverley PM: Hyperglycaemia as a predictor of outcome during non-invasive ventilation in decompensated COPD. Thorax 2009;64:857-862.
[PubMed]
7.
Chase JG, Shaw G, Le Compte A, Lonergan T, Willacy M, Wong XW, Lin J, Lotz T, Lee D, Hann C: Implementation and evaluation of the sprint protocol for tight glycaemic control in critically ill patients: a clinical practice change. Crit Care 2008;12:R49.
[PubMed]
8.
Combes A, Luyt CE, Trouillet JL, Nieszkowska A, Chastre J: Gender impact on the outcomes of critically ill patients with nosocomial infections. Crit Care Med 2009;37:2506-2511.
[PubMed]
9.
Costello JM, Morrow DF, Graham DA, Potter-Bynoe G, Sandora TJ, Laussen PC: Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 2008;121:915-923.
[PubMed]
10.
Dossett LA, Cao H, Mowery NT, Dortch MJ, Morris JM Jr, May AK: Blood glucose variability is associated with mortality in the surgical intensive care unit. Am Surg 2008;74:679-685.
[PubMed]
11.
General Assembly of the World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent 2014;81:14-18.
[PubMed]
12.
Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D: Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 2009;180:821-827.
[PubMed]
13.
Gunst J, Derese I, Aertgeerts A, Ververs EJ, Wauters A, van den Berghe G, Vanhorebeek I: Insufficient autophagy contributes to mitochondrial dysfunction, organ failure, and adverse outcome in an animal model of critical illness. Crit Care Med 2013;41:182-194.
[PubMed]
14.
Hirshberg E, Larsen G, van Duker H: Alterations in glucose homeostasis in the pediatric intensive care unit: hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med 2008;9:361-366.
[PubMed]
15.
Iorio R, Williams KM, Marcantonio AJ, Specht LM, Tilzey JF, Healy WL: Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplasty 2012;27:726-729 e721.
[PubMed]
16.
Kawahito S, Kitahata H, Oshita S: Problems associated with glucose toxicity: role of hyperglycemia-induced oxidative stress. World J Gastroenterol 2009;15:4137-4142.
[PubMed]
17.
Kett DH, Azoulay E, Echeverria PM, Vincent JL, et al: Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med 2011;39:665-670.
[PubMed]
18.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
[PubMed]
19.
Knowles SJ: Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp Infect 2009;71:95-96; author reply 96-97.
[PubMed]
20.
Krinsley JS: Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med 2008;36:3008-3013.
[PubMed]
21.
NICE-SUGAR Study Investigators: Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283-1297.
[PubMed]
22.
Peleg AY, Hooper DC: Hospital-acquired infections due to Gram-negative bacteria. N Engl J Med 2010;362:1804-1813.
[PubMed]
23.
Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheira M: Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in intensive care unit (ICU) and non-ICU settings in the sentry antimicrobial surveillance program (2008-2009). Int J Antimicrob Agents 2011;38:65-69.
[PubMed]
24.
Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli DJ, Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D: Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.
[PubMed]
25.
Que RS, Cao LP, Ding GP, Hu JA, Mao KJ, Wang GF: Correlation of nitric oxide and other free radicals with the severity of acute pancreatitis and complicated systemic inflammatory response syndrome. Pancreas 2010;39:536-540.
[PubMed]
26.
Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, Rogers SO: Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 2008;248:585-591.
[PubMed]
27.
Safavi M, Honarmand A: The impact of admission hyperglycemia or hypoalbuminemia on need ventilator, time ventilated, mortality, and morbidity in critically ill trauma patients. Ulus Travma Acil Cerrahi Derg 2009;15:120-129.
[PubMed]
28.
Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao PG: Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med 2009;16:239-247.
[PubMed]
29.
Torres A, Ewig S, Lode H, Carlet J, et al: Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009;35:9-29.
[PubMed]
30.
van den Berghe G, Schetz M, Vlasselaers D, Hermans G, Wilmer A, Bouillon R, Mesotten D: Clinical review: intensive insulin therapy in critically ill patients: NICE-SUGAR or Leuven blood glucose target? J Clin Endocrinol Metab 2009;94:3163-3170.
[PubMed]
31.
Vanhorebeek I, Gunst J, Ellger B, Boussemaere M, Lerut E, Debaveye Y, Rabbani N, Thornalley PJ, Schetz M, van den Berghe G: Hyperglycemic kidney damage in an animal model of prolonged critical illness. Kid Int 2009;76:512-520.
[PubMed]
32.
Zilberberg MD, Shorr AF: Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis 2010;51(suppl 1):S131-S135.
[PubMed]
You do not currently have access to this content.