The Incidence and Risk Factors of Stress Hyperglycaemia in Patients Who Received Enteral Nutrition in Intensive Care Units: A Retrospective Cohort Study.

Abstract

Aim and objectives: This study aimed to investigate the incidence and identify risk factors of stress hyperglycaemia among patients who received enteral nutrition (EN) in the intensive care unit (ICU).

Background: Stress hyperglycaemia is common among ICU patients receiving EN and is related to worse outcomes. However, the factors associated with stress hyperglycaemia during EN remain unclear, especially among patients who are not diagnosed with diabetes.

Design: A retrospective cohort study.

Methods: Electronic medical records of 614 non-diabetic patients receiving EN at two ICUs in Guizhou Provincial People's Hospital were reviewed. Patients were classified into hyperglycemic and non-hyperglycemic groups. Social demographics, clinical characteristics, treatment regimens, nutrition therapy, and point-of-care blood glucose values were collected. Univariate and multivariable analyses identified risk factors for stress hyperglycaemia. This study followed the STROBE guideline.

Results: The incidence of stress hyperglycaemia among ICU patients without diabetes receiving EN was 35.50%. Multivariable analysis revealed that obesity (BMI ≥ 28 kg/m²), high carbohydrate intake (> 5.0 g/kg/day), and the use of semi-elemental EN solutions were independent risk factors for stress hyperglycaemia. In contrast, a moderate carbohydrate intake (3.0-3.9 g/kg/day) was associated with a significantly lower risk of stress hyperglycaemia.

Conclusions: The 35.50% of ICU patients without diabetes experienced stress hyperglycaemia during EN. Potential risk factors included BMI ≥ 28 kg/m², high carbohydrate intake (> 5.0 g/kg/day), and the use of semi-elemental EN solutions. A moderate carbohydrate intake (3.0-3.9 g/kg/day) was protective. Future research should explore optimal carbohydrate intake ranges and personalised nutrition protocols to reduce stress hyperglycaemia in critically ill patients.

Relevance to clinical practice: Reducing stress hyperglycaemia in ICU patients without diabetes receiving EN is crucial. Recommendations include monitoring patients with BMI ≥ 28 kg/m² and considering moderate carbohydrate intake (3.0-3.9 g/kg/day), and reasonably selecting the type of enteral nutrition solution based on the patient's individual condition.