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Hyperglycemia is common in critically ill patients, even in those without diabetes. In fact, hyperglycemia has been known to increase mortality in patients with and without diabetes in the settings of acute critical illness. It has been known that relative risks of mortality and morbidity in hyperglycemic and normoglycemic patients among diabetes or nondiabetes are different. In a systematic overview, hyperglycemia after acute myocardial infarction increased the risk of in-hospital mortality in patients with and without diabetes, but the relative risks of hyperglycemia in patients with diabetes were smaller than that in patients without diabetes. And the risk of congestive heart failure or cardiogenic shock was increased in patients without diabetes, not in those with diabetes. The other systematic overview show that hyperglycemia in patients without diabetes compared to those with diabetes was associated with a higher risk in-hospital mortality after acute stroke. Most studies evaluated the prognosis of the patients with vascular diseases such as myocardial infarction or acute stroke. Aim of this study was to evaluate the effect of hyperglycemia on the prognosis in a heterogenous group of critically ill patients with or without diabetes. Background: Hyperglycemia is common in critically ill patients, even in those without diabetes, and it is known to increase mortality in patients with or without diabetes in the settings of acute myocardial infarction or acute stroke. However, the clinical effects of admission hyperglycemia are uncertain, and no data is available that compares the prognosis in a heterogenous group of critically ill patients. The aim of this study was to evaluate the effect of hyperglycemia on prognosis in a heterogenous group of critically ill patients with or without diabetes. Methods: The medical records of 858 consecutive adult patients admitted to a general intensive care unit (ICU) at a University Hospital over 21 months were reviewed. Patients with no records of blood glucose measurements and patients with normoglycemia during the first 3 days were excluded. The remaining 349 patients with hyperglycemia were divided into two groups according to a previous history of diabetes. Hyperglycemia was defined as a fasting blood glucose level of 140 mg/dl or more, or a random blood glucose level of 200 mg/dl or more on 2 or more determinations. The primary end-point of the study was ICU and in-hospital mortality, and its secondary end-point included length of stay in the ICU and hospital. Results: There were no significant differences in ICU mortality (17.6/19.0%), in-hospital mortality (24.5/24.3%), ICU length of stay (6.6 ± 11.9/6.6 ± 10.4 days), and hospital length of stay (11.4 ± 29.0/12.8 ± 24.3 days) between diabetics and nondiabetics. Conclusions: Our results indicate that the effects of hyperglycemia on the prognosis of critically ill patients do not differ diabetics from nondiabetics. (Korean J Anesthesiol 2004; 47: S 10∼S 13)

The Effect of Hyperglycemia on the Prognosis of Critically Ill Patients Does Not Differ Diabetics from Nondiabetics