A systematic scoping review on the consequences of stress-related hyperglycaemia.
Level 3 - non-randomized controlled study
Systematic scoping review of observational cohort studies
PubMed 29624594 · doi:10.1371/journal.pone.0194952
What was done
A systematic scoping review following Joanna Briggs Institute methodology searched Medline, Embase, and the Cochrane Library (January 2000 to December 2015). The authors analyzed observational studies reporting on stress-related hyperglycaemia (SHG) and outcomes (mortality, infection rate, length of stay, duration of mechanical ventilation, blood transfusions, renal replacement therapy, or acquired weakness) in acutely ill ICU patients.
What was found
From 3,063 initial articles, 43 observational studies totaling 536,476 patients met inclusion criteria. Forty studies compared outcomes between patients with and without SHG. Frequently reported outcomes included mortality (38 studies), ICU length of stay (23 studies), hospital length of stay (18 studies), and duration of mechanical ventilation (13 studies). Fourteen studies (35.9%) found an association between hyperglycaemia and increased mortality, with odds ratios ranging from 1.13 to 2.76. Five studies identified SHG as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.
Why it matters
This review highlights a consistent signal linking stress-related hyperglycaemia to worse outcomes in critical illness while demonstrating that clinical definitions and monitoring methods remain too fractured for direct quantitative comparison.
Limits
The review included only observational studies, precluding causal conclusions. The included literature had wide divergences in SHG definitions, blood glucose measurement techniques, monitoring protocols, and treatment thresholds, preventing meta-analytic pooling.
Cited by
- context Infection-induced cortisol elevation typically raises blood sugar to 120-130 mg/dL for three to fifteen days.