Diabetes Does Not Influence Selected Clinical Outcomes in Critically Ill Burn Patients
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Objective Evaluate glucose control and clinical outcomes in diabetic burn ICU patients. Methods We reviewed 462 civilian patients admitted to our burn ICU over four years. Exclusion criteria were age18, admission because of skin infection, incomplete records, and military patients. Subjects were labeled as diabetic if they had a diagnosis of diabetes documented in their medical records. Otherwise they were labeled as non-diabetic. Diabetics n57 were compared to non-diabetics n405. Admission glucose levels were obtained from chemistries. Point-of-care devices provided the remaining glucose values. While in the burn ICU hyperglycemia for all patients was treated using intensive insulin therapy with a target blood glucose goal of 80 110mgdL. Mann-Whitney U, Chi-square, and multivariate regressions were used for statistical analysis p 0.05. Results Diabetics were older 60 15 vs 44 17years with higher admission glucose 196 81 vs 133 52mgdL, mean glucose 147 37 vs 122 24mgdL, glucose variability 30 11 vs 22 11, and fewer ICU-free days 18 12 vs 20 11. After multivariate regression analyses age, ISS, TBSA, admission glucose, and mean glucose significantly affected the number of ventilatorfree days, ICU-free days, and hospital-free days. Glucose variability was associated with hospitalfree days only. Age, ISS, and TBSA significantly influenced mortality whereas a pre-existing diagnosis of diabetes was not associated with any clinical outcomes. Conclusions Admission blood glucose is higher and blood glucose is more difficult to control in diabetic burn ICU patients. A pre-existing diagnosis of diabetes does not influence clinical outcomes in critically ill burn patients.
- Medicine and Medical Research