Hyperglycaemia is associated with fungaemia and an increased mortality rate in severely burned children

Background Hyperglycaemia may have detrimental effects on immunity. The purpose of this study was to assess any relationship between hyperglycaemia and clinical outcome following injury. Methods The records of children with burns covering 60 per cent or more of the body surface admitted after 1996 were reviewed. Patients were categorized as having poor glucose control if 40 per cent or more of all plasma glucose determinations were 7·8 mmol l −1 or greater and were compared with patients with adequate glucose control (less than 40 per cent of glucose values 7·8 mmol l −1 or greater). Results Despite similar age, burn size and caloric intake, the extent and severity of hyperglycaemia was significantly greater in the 33 patients categorized as having poor glucose control than in the 25 patients with adequate glucose control. Patients with hyperglycaemia had a significantly higher proportion of blood cultures positive for yeast (mean(s.d.) 3·7(10·0) versus 0·1(0·7) per cent; P < 0·05, Student's t test). Nine of 33 patients with persistent hyperglycaemia died, compared with only one of 25 with adequate glucose control ( P ≤ 0·05, Fisher's exact test). Conclusion This association between hyperglycaemia, fungaemia and subsequent death in severely burned children may be related to a hyperglycaemia‐induced deterioration in immune function. This suggests that aggressive manoeuvres to normalize plasma glucose may be warranted. © 2000 British Journal of Surgery Society Ltd