Applied nutritional investigation Hyperglycemia and hypoalbuminemia as prognostic mortality factors in patients with enteral feeding Carlos Alfredo Gonz  alez Infantino M.D. a, * , Claudio Daniel Gonz  alez M.D. b , Ruth S  anchez L.Nutr. a , Natalia Presner L.Nutr. a a Hospital de Cl  ınicas “Jos e de San Mart  ın”, School of Medicine, Buenos Aires University, Buenos Aires, Argentina b Department of Pharmacology, School of Medicine, Buenos Aires University, Buenos Aires, Argentina article info Article history: Received 12 April 2012 Accepted 25 July 2012 Keywords: Enteral feeding Hyperglycemia Hypoalbuminemia Diabetes Mortality abstract Objective: To determine the association of in-hospital mortality in patients with enteral feeding to their glycemic status (normoglycemia, new hyperglycemia, or diabetes) and their levels of serum albumin. Methods: This was an observational, retrospective, descriptive, and longitudinal study. The data were from patients hospitalized at Hospital de Cl  ınicas “Jos e de San Mart  ın” during a 4-y period who had received enteral feeding during the hospitalization period. P < 0.05 was considered statistically significant. Results: Of the 1004 included patients, 558 (55.6%) had normoglycemia, 219 (21.8%) had known diabetes, and 227 (22.6%) had newly diagnosed hyperglycemia. The crude mortality rates during hospitalization were more pronounced for the hyperglycemic and diabetic patients. The univariate relative risks for trend were 1.34 and 1.56 for the diabetic and hyperglycemic subjects, respectively. At univariate analysis, in-hospital mortality was associated with age, known diabetes, newly diagnosed hyperglycemia, and albumin level. Hypoalbuminemia (<2.55 g/dL) also was significantly associated with mortality (univariate odds ratio z2.7). At multivariate analysis, in-hospital mortality was associated with age, newly diagnosed hyperglycemia, hypoalbuminemia (<2.55 g/ dL), and known diabetes. No interactions between hypoalbuminemia and known diabetes or newly diagnosed hyperglycemia were detected at multivariate analysis. Conclusion: The results of this study showed that newly diagnosed hyperglycemia can be consid- ered an independent prognostic factor of in-hospital mortality in patients with enteral feeding and that there is no interaction between newly diagnosed hyperglycemia and serum albumin levels. Ó 2013 Elsevier Inc. All rights reserved. Introduction Hyperglycemia and insulin resistance are common metabolic disorders in patients with severe injury, even without a previous diagnosis of diabetes [1]. These conditions can dispose to complications such as severe infections because of immune function alterations [2–5] and inflammatory response impair- ments [6]. Van Den Berghe et al. [7] hypothetically proposed in their trial on intensive insulin therapy in critically ill patients that hyperglycemia during critical illness may confer a predisposition to complications such as severe infections, multiple-organ failure, and death. Hyperglycemia impairs leukocyte function, phagocytosis, and chemotaxis; increases inflammatory cytokines and oxidative stress [8]; and generates a toxic cellular environment, causing intra- and extracellular dehydration and inducing electrolytic abnormalities. For this reason, the hyperglycemia is considered an important cause of morbidity/mortality. In 2002, Umpierrez et al. [9] published a study of 2030 adult patients admitted to the intensive care unit (ICU), general medicine, and surgery wards, which showed that newly diag- nosed hyperglycemic patients had a higher in-hospital mortality rate (16%) compared with those patients with a history of dia- betes (3%) and subjects with normoglycemia (1.7%; P < 0.01). The detrimental consequences of hyperglycemia also have been observed in patients with total parenteral nutrition (TPN) [10]. A study published in 2010 found that blood glucose levels * Corresponding author. Tel.: þ54-115-950-8954; fax: þ54-115-950-8956. E-mail address: gonzalezinfantino@fibertel.com.ar (C. A. Gonz alez Infantino). 0899-9007/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nut.2012.07.019 Contents lists available at ScienceDirect Nutrition journal homepage: www.nutritionjrnl.com Nutrition 29 (2013) 497–501