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The relationship between acute and chronic hyperglycemia and outcomes in burn injury
A significant proportion of patients with burn injury have diabetes. Although hyperglycemia during critical illness has been associated with poor outcomes, patients with chronic hyperglycemia based on elevated hemoglobin A1c (HbA1c) measurements at admission have been shown to tolerate higher glucos...
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| Published in: | Journal of burn care & research 2013-01, Vol.34 (1), p.109-114 |
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| cited_by | cdi_FETCH-LOGICAL-c474t-7d3653271cdfcbf41f9d940158949bc0335f03655354c96cd5c4d239efdefd393 |
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| cites | cdi_FETCH-LOGICAL-c474t-7d3653271cdfcbf41f9d940158949bc0335f03655354c96cd5c4d239efdefd393 |
| container_end_page | 114 |
| container_issue | 1 |
| container_start_page | 109 |
| container_title | Journal of burn care & research |
| container_volume | 34 |
| creator | Murphy, Claire V Coffey, Rebecca Wisler, Jon Miller, Sidney F |
| description | A significant proportion of patients with burn injury have diabetes. Although hyperglycemia during critical illness has been associated with poor outcomes, patients with chronic hyperglycemia based on elevated hemoglobin A1c (HbA1c) measurements at admission have been shown to tolerate higher glucose levels during hospitalization. This relationship has not been evaluated in the burn population. The objective of this study was to examine the impact of chronic glucose control on outcomes in the acute period after burn. This is a retrospective analysis comparing outcomes in patients with chronic hyperglycemia (HbA1c ≥ 6.5%) and euglycemia (HbA1c |
| doi_str_mv | 10.1097/BCR.0b013e3182700025 |
| format | article |
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Although hyperglycemia during critical illness has been associated with poor outcomes, patients with chronic hyperglycemia based on elevated hemoglobin A1c (HbA1c) measurements at admission have been shown to tolerate higher glucose levels during hospitalization. This relationship has not been evaluated in the burn population. The objective of this study was to examine the impact of chronic glucose control on outcomes in the acute period after burn. This is a retrospective analysis comparing outcomes in patients with chronic hyperglycemia (HbA1c ≥ 6.5%) and euglycemia (HbA1c <6.5%). Patients aged 18 to 89 years, admitted for initial burn care between January 1, 2009, and June 30, 2010, with an HbA1c measurement at admission were included. The primary endpoint was unplanned readmissions, with secondary endpoints of length of stay and mortality. We included 258 patients (32 with chronic hyperglycemia and 226 with euglycemia). Burn severity was similar between the groups. Patients with chronic hyperglycemia were significantly older and were more likely to have diabetes, respiratory disease, and hypertension. Chronic hyperglycemia was associated with significantly higher time-weighted glucose and glucose variability. Survival rates were similar, but the chronic hyperglycemia group had a significantly longer length of stay (13 vs 9 days; P = .038) and a higher rate of unplanned readmission (18.8 vs 3.6%; P = .001). Chronic hyperglycemia before burn injury is associated with altered glycemic response after burn injury and worse outcomes. Further research is needed to identify whether chronic hyperglycemia necessitates a modified approach to burn care or glycemic management.</description><identifier>ISSN: 1559-047X</identifier><identifier>EISSN: 1559-0488</identifier><identifier>DOI: 10.1097/BCR.0b013e3182700025</identifier><identifier>PMID: 23292578</identifier><language>eng</language><publisher>England</publisher><subject>Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Burns - complications ; Burns - physiopathology ; Chi-Square Distribution ; Chronic Disease ; Endpoint Determination ; Female ; Glycated Hemoglobin A - analysis ; Humans ; Hyperglycemia - complications ; Hyperglycemia - physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Statistics, Nonparametric ; Survival Rate</subject><ispartof>Journal of burn care & research, 2013-01, Vol.34 (1), p.109-114</ispartof><rights>Copyright © 2013 by the American Burn Association. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-7d3653271cdfcbf41f9d940158949bc0335f03655354c96cd5c4d239efdefd393</citedby><cites>FETCH-LOGICAL-c474t-7d3653271cdfcbf41f9d940158949bc0335f03655354c96cd5c4d239efdefd393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,4022,27922,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23292578$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Murphy, Claire V</creatorcontrib><creatorcontrib>Coffey, Rebecca</creatorcontrib><creatorcontrib>Wisler, Jon</creatorcontrib><creatorcontrib>Miller, Sidney F</creatorcontrib><title>The relationship between acute and chronic hyperglycemia and outcomes in burn injury</title><title>Journal of burn care & research</title><addtitle>J Burn Care Res</addtitle><description>A significant proportion of patients with burn injury have diabetes. Although hyperglycemia during critical illness has been associated with poor outcomes, patients with chronic hyperglycemia based on elevated hemoglobin A1c (HbA1c) measurements at admission have been shown to tolerate higher glucose levels during hospitalization. This relationship has not been evaluated in the burn population. The objective of this study was to examine the impact of chronic glucose control on outcomes in the acute period after burn. This is a retrospective analysis comparing outcomes in patients with chronic hyperglycemia (HbA1c ≥ 6.5%) and euglycemia (HbA1c <6.5%). Patients aged 18 to 89 years, admitted for initial burn care between January 1, 2009, and June 30, 2010, with an HbA1c measurement at admission were included. The primary endpoint was unplanned readmissions, with secondary endpoints of length of stay and mortality. We included 258 patients (32 with chronic hyperglycemia and 226 with euglycemia). Burn severity was similar between the groups. Patients with chronic hyperglycemia were significantly older and were more likely to have diabetes, respiratory disease, and hypertension. Chronic hyperglycemia was associated with significantly higher time-weighted glucose and glucose variability. Survival rates were similar, but the chronic hyperglycemia group had a significantly longer length of stay (13 vs 9 days; P = .038) and a higher rate of unplanned readmission (18.8 vs 3.6%; P = .001). Chronic hyperglycemia before burn injury is associated with altered glycemic response after burn injury and worse outcomes. Further research is needed to identify whether chronic hyperglycemia necessitates a modified approach to burn care or glycemic management.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Burns - complications</subject><subject>Burns - physiopathology</subject><subject>Chi-Square Distribution</subject><subject>Chronic Disease</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Humans</subject><subject>Hyperglycemia - complications</subject><subject>Hyperglycemia - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Statistics, Nonparametric</subject><subject>Survival Rate</subject><issn>1559-047X</issn><issn>1559-0488</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNpdUV1r3DAQFKWhl17yD0LwY18uXX2drJdAe_QLDgLhAnkTsryOFWzpItkp9-_j9JIjDSzMwszOLjuEnFG4oKDV1--r6wuogHLktGQKAJj8QI6plHoBoiw_Hnp1OyOfc74HEAKU_ERmjDPNpCqPyWbTYpGws4OPIbd-W1Q4_EUMhXXjgIUNdeHaFIN3RbvbYrrrdg57b_8xcRxc7DEXPhTVmMKE92PanZCjxnYZT19wTm5-_tisfi_WV7_-rL6tF04oMSxUzZeSM0Vd3biqEbTRtRZAZamFrhxwLhuYJJJL4fTS1dKJmnGNTT0V13xOLve-27HqsXYYhmQ7s02-t2lnovXmfyb41tzFR8NL0BrEZPDlxSDFhxHzYHqfHXadDRjHbChTnC3L6VOTVOylLsWcEzaHNRTMcyBmCsS8D2QaO3974mHoNQH-BJtUiUQ</recordid><startdate>201301</startdate><enddate>201301</enddate><creator>Murphy, Claire V</creator><creator>Coffey, Rebecca</creator><creator>Wisler, Jon</creator><creator>Miller, Sidney F</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201301</creationdate><title>The relationship between acute and chronic hyperglycemia and outcomes in burn injury</title><author>Murphy, Claire V ; Coffey, Rebecca ; Wisler, Jon ; Miller, Sidney F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-7d3653271cdfcbf41f9d940158949bc0335f03655354c96cd5c4d239efdefd393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Burns - complications</topic><topic>Burns - physiopathology</topic><topic>Chi-Square Distribution</topic><topic>Chronic Disease</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Humans</topic><topic>Hyperglycemia - complications</topic><topic>Hyperglycemia - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Statistics, Nonparametric</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murphy, Claire V</creatorcontrib><creatorcontrib>Coffey, Rebecca</creatorcontrib><creatorcontrib>Wisler, Jon</creatorcontrib><creatorcontrib>Miller, Sidney F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of burn care & research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murphy, Claire V</au><au>Coffey, Rebecca</au><au>Wisler, Jon</au><au>Miller, Sidney F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The relationship between acute and chronic hyperglycemia and outcomes in burn injury</atitle><jtitle>Journal of burn care & research</jtitle><addtitle>J Burn Care Res</addtitle><date>2013-01</date><risdate>2013</risdate><volume>34</volume><issue>1</issue><spage>109</spage><epage>114</epage><pages>109-114</pages><issn>1559-047X</issn><eissn>1559-0488</eissn><abstract>A significant proportion of patients with burn injury have diabetes. Although hyperglycemia during critical illness has been associated with poor outcomes, patients with chronic hyperglycemia based on elevated hemoglobin A1c (HbA1c) measurements at admission have been shown to tolerate higher glucose levels during hospitalization. This relationship has not been evaluated in the burn population. The objective of this study was to examine the impact of chronic glucose control on outcomes in the acute period after burn. This is a retrospective analysis comparing outcomes in patients with chronic hyperglycemia (HbA1c ≥ 6.5%) and euglycemia (HbA1c <6.5%). Patients aged 18 to 89 years, admitted for initial burn care between January 1, 2009, and June 30, 2010, with an HbA1c measurement at admission were included. The primary endpoint was unplanned readmissions, with secondary endpoints of length of stay and mortality. We included 258 patients (32 with chronic hyperglycemia and 226 with euglycemia). Burn severity was similar between the groups. Patients with chronic hyperglycemia were significantly older and were more likely to have diabetes, respiratory disease, and hypertension. Chronic hyperglycemia was associated with significantly higher time-weighted glucose and glucose variability. Survival rates were similar, but the chronic hyperglycemia group had a significantly longer length of stay (13 vs 9 days; P = .038) and a higher rate of unplanned readmission (18.8 vs 3.6%; P = .001). Chronic hyperglycemia before burn injury is associated with altered glycemic response after burn injury and worse outcomes. Further research is needed to identify whether chronic hyperglycemia necessitates a modified approach to burn care or glycemic management.</abstract><cop>England</cop><pmid>23292578</pmid><doi>10.1097/BCR.0b013e3182700025</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of burn care & research, 2013-01, Vol.34 (1), p.109-114 |
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| language | eng |
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| source | Oxford Journals Online |
| subjects | Acute Disease Adolescent Adult Aged Aged, 80 and over Burns - complications Burns - physiopathology Chi-Square Distribution Chronic Disease Endpoint Determination Female Glycated Hemoglobin A - analysis Humans Hyperglycemia - complications Hyperglycemia - physiopathology Male Middle Aged Retrospective Studies Statistics, Nonparametric Survival Rate |
| title | The relationship between acute and chronic hyperglycemia and outcomes in burn injury |
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