Impact of dysglycemia during the ebb and flow phases of critically ill burn patients: An observational study.

Abstract

Critically ill burn patients face severe metabolic stress, divided into early ebb and late flow phases, causing dysglycemia. While detrimental effects of hyper- and hypoglycemia in burn patients have been reported over the entire stay, its impact during the ebb and flow phases remains unexplored. This study is the first to investigate phase-separated dysglycemia for outcome prediction. This retrospective, single-center observational study examined burn ICU patients between 2009 and 2022. Non-severe (ABSI<7) and severe (ABSI≥7) burn patients were investigated separately. Furthermore, the effect of low (<50 %) versus high (≥50 %) dysglycemic rates (<70 or >140 mg/dL) was evaluated within the ebb and flow phases. Dysglycemia was calculated using the time-unified rate, an innovative method representing blood glucose over time. The primary outcome of this study was mortality. This study included 67 non-severe and 101 severe burn patients. During the flow compared to the ebb phase, non-severe burn patients showed increased hyperglycemic rates (>140 mg/dL, p = 0.027) and mean blood glucose levels (p = 0.003), while severe burn patients showed increased glycemic variability (p < 0.001) and hypoglycemic rates (<70 mg/dL, p = 0.003). Non-severe burn patients with high dysglycemic rates showed increased length of ICU stay (ebb: p = 0.029, flow: p = 0.040) and pneumonia incidence (ebb: p = 0.005, flow: p = 0.002) compared to patients with low dysglycemic rates. High dysglycemic rate was associated with higher mortality in severe burn patients (ebb: p = 0.027, flow: p = 0.008). Multivariate logistic regression revealed that hyper- (OR: 1.034, 95 %-CI: [1.001-1.068], p = 0.045) and hypoglycemic rates (OR: 1.744, 95 %-CI: [1.180-2.577], p = 0.005) during the flow, but not the ebb phase, predicted mortality in severe burn patients. This study suggests that increased dysglycemic rate plays a relevant role in both non-severe and severe burn patients, with a varying impact. Over time, the flow phase was characterized by higher glycemic variability as well as hyper- and hypoglycemic rates, with the latter two predicting mortality in severe burn patients. While larger cohorts are needed to confirm these findings, the data indicate that reducing the dysglycemic rate, particularly during the flow phase, could improve outcomes in critically ill burn patients.