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

IF 3.5 3区医学 Q1 NURSING Journal of Clinical Nursing Pub Date : 2025-03-03 DOI:10.1111/jocn.17714

Huan Yao, Yukang Dong, Yan Jiang, Gui Xiao, Hai Gao, Jia Guo

{"title":"The Incidence and Risk Factors of Stress Hyperglycaemia in Patients Who Received Enteral Nutrition in Intensive Care Units: A Retrospective Cohort Study","authors":"Huan Yao, Yukang Dong, Yan Jiang, Gui Xiao, Hai Gao, Jia Guo","doi":"10.1111/jocn.17714","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim and Objectives</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>A retrospective cohort study.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The incidence of stress hyperglycaemia among ICU patients without diabetes receiving EN was 35.50%. Multivariable analysis revealed that obesity (BMI ≥ 28 kg/m<sup>2</sup>), 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The 35.50% of ICU patients without diabetes experienced stress hyperglycaemia during EN. Potential risk factors included BMI ≥ 28 kg/m<sup>2</sup>, 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.</p>\n </section>\n \n <section>\n \n <h3> Relevance to Clinical Practice</h3>\n \n <p>Reducing stress hyperglycaemia in ICU patients without diabetes receiving EN is crucial. Recommendations include monitoring patients with BMI ≥ 28 kg/m<sup>2</sup> 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.</p>\n </section>\n </div>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"34 11","pages":"4654-4663"},"PeriodicalIF":3.5000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Nursing","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jocn.17714","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

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.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

重症监护病房接受肠内营养的患者应激性高血糖的发生率和危险因素：一项回顾性队列研究。

目的和目的：本研究旨在调查重症监护病房（ICU）接受肠内营养（EN）的患者应激性高血糖的发生率并确定危险因素。背景：应激性高血糖在接受EN治疗的ICU患者中很常见，并与较差的预后有关。然而，与EN期间应激性高血糖相关的因素仍不清楚，特别是在未诊断为糖尿病的患者中。设计：回顾性队列研究。方法：对贵州省人民医院2个icu 614例接受EN治疗的非糖尿病患者的电子病历进行回顾性分析。将患者分为高血糖组和非高血糖组。收集社会人口统计、临床特征、治疗方案、营养治疗和护理点血糖值。单变量和多变量分析确定了应激性高血糖的危险因素。本研究遵循STROBE指南。结果：非糖尿病ICU患者接受EN治疗后应激性高血糖发生率为35.50%。多变量分析显示，肥胖（BMI≥28 kg/m2）、高碳水化合物摄入量（> 5.0 g/kg/day）和使用半单质EN溶液是应激性高血糖的独立危险因素。相反，适度的碳水化合物摄入（3.0-3.9 g/kg/天）与应激性高血糖的风险显著降低相关。结论：35.50%的非糖尿病ICU患者在EN期间出现应激性高血糖。潜在的危险因素包括BMI≥28 kg/m2，高碳水化合物摄入量（> 5.0 g/kg/天），以及使用半元素EN溶液。适度的碳水化合物摄入（3.0-3.9 g/kg/天）具有保护作用。未来的研究应探索最佳的碳水化合物摄入范围和个性化的营养方案，以减少危重患者的应激性高血糖。与临床实践的相关性：降低接受EN治疗的非糖尿病ICU患者的应激性高血糖至关重要。建议监测BMI≥28 kg/m2的患者，考虑适当的碳水化合物摄入（3.0-3.9 g/kg/天），并根据患者的个体情况合理选择肠内营养液的种类。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Clinical Nursing 医学-护理

CiteScore

6.40

自引率

2.40%

发文量

审稿时长

2 months

期刊介绍： The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice. JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice. We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.