Evaluation of occurrence of acute hyperglycemia and its association with outcome in patients with severe burns hospitalized at KNH
Background: Hyperglycemia is one of the most prominent features of the hyper-metabolic response among patients suffering major burn injury. It has been associated with poor outcome in patients with severe burns and other major trauma, while early recognition and treatment of this profound metabolic change has been shown to improve clinical outcome. This study aimed at evaluating whether hyperglycemia is associated with the high morbidity and mortality observed in patients with severe burns admitted at Kenyatta National Hospital (KNH), burns unit. This was with the aim of providing recommendations for glycemic control in these patient population. Objectives: To evaluate the occurrence of acute hyperglycaemia and its association with outcome in patients with severe burn injury, hospitalized at Kenyatta National Hospital. Materials and Methods: The study was a prospective cross-sectional descriptive study, carried out at the Kenyatta National Hospital (KNH). The patients who met the inclusion criteria were recruited into the study for a period of 6 months, and a structured questionnaire was used to collect data. Random blood sugar samples were collected and analyzed in the first week of the study. Patients were followed-up and assessed for duration of hospital stay and mortality. Data was analyzed using univariate and multivariate analysis methods and presented through graphs, charts and tables. Results: The mean blood glucose increased with time from 6.4 mmol/ l on day 1 to an average of 9.6 mmol/ l on day 7. The percentage of patients with hyperglycemia increased from 9.1% to 51.1% (p < 0.001). Further increase in prevalence of hyperglycemia on day 7 was noted but this increase was not significant compared to day 3 (p = 0.87). The case fatality for burn patients with hyperglycemia at KNH burns unit was 24%. Mortality was persistently higher among patients with hyperglycemia in all 3 days compared to the patients with normo-glycaemia, [day 1 (55.6%) v/s (20%) (p = 0.029), day 3 (22.9%) v/s (15.2%) (p = 0.34) and day 7 (19.6%) v/s (9.5%) (p = 0.24)]. The presence of hyperglycemia on day 1 was significantly associated with reduced duration of burns unit stay (p = 0.026), while the Hyperglycemia on day 3 or 7 did not predict duration of hospital stay with median duration of stay of between 10 days and 15 days. Conclusion: From the study, it is clear that hyperglycemia is associated with increased morbidity and mortality among patients admitted with severe burns at KNH. Therefore, there is a need to institute regular monitoring of blood sugar levels among patients with severe burns and give appropriate treatment for those found with deranged blood sugar levels.