الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hyperglycaemia commonly occurs in the course of any critical illness, after the acute illness subsides, blood glucose returns to normal.
Critical illness hyperglycaemia caused by mediators of stress and inflammation. Severity of disease is the main risk factor for development of hyperglycaemia (Ivan et al., 2010).
Many studies had shown the association of stress hyperglycemia with the worse outcomes of the critically ill patients (Benefield et al., 2007).
The aim of our work is to study the prevalence of stress hyperglycemia among critically ill patients, for achievement of this aim, we studied 218 successive patients admitted to the medical ICU in internal medicine department. Random blood sugar was done to the 218 patients on day of admission to the ICU, the incidence of stress hyperglycemia was assessed among the 218 patients and proper history was taken and clinical examination was done,then HbA1c was measured to the group showed hyperglycemia)RBS>140mg/dl).The severity of critical illness was assessed by the SOFA score.
Our results revealed that there were 168 (77.1%) patients admitted with random blood glucose (RBS) >140 mg/dl (Hyperglycemic patients) and Prevalence of patients with stress hyperglycemia was 113(51.8%) among the studied sample of patients (218), we found that the percentage of controlled patients
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(HbA1c < 7) among diabetic patients taking medication was only 44 (48.4 %) patients in our sample (n=91). On studying the past medical history among the studied three groups (Normoglycemic, chronic hyperglycemic and Stress hyperglycemic groups), we found the significant prevalence of hypertension (HTN), cardiac and liver diseases among the stress hyperglycemic group than the chronic hyperglycemic group (P 0.005, 0.01, 0.05). Also we found the significant prevalence of diabetes mellitus among the chronic hyperglycemic group in comparison to the stress hyperglycemic group and the normoglycemic group with a P value < 0.001.
As regard the laboratory parameters of the three studied groups inside the sample, the White blood cells (WBCs) count was significantly higher in the chronic hyperglycemia group than in the normoglycemia group (p=0.001) and in the stress hyperglycemia group than in the normoglycemic group (0.003), Prothrombin concentration was lower in Stress hyperglycemia group than both in the chronic hyperglycemia group (P=0.001) and in the normoglycemia group (P=0.05). Also we found that Serum Alanine transferase (ALT) was higher in the stress hyperglycemia group than in the normoglycemia group with a statistically significant difference (P=0.002), also Total and Direct bilirubin was significantly higher in the stress hyperglycemia group than in the chronic hyperglycemia group (p= 0.01 and 0.006 respectively). HbA1c was 5.69±0.61 in the stress hyperglycemia
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group, 8.47±1.51 in the chronic hyperglycemia group and 4.90±1.04 in the normoglycemia group with a statistical significant difference (P<0.001).
In our study, mean arterial pressure (MAP) was significantly higher in the chronic hyperglycemia group than in the stress hyperglycemia group (P = 0.04), we noticed that patients with chronic hyperglycemia also showed uncontrolled hypertension. Glasgow coma scale (GCS) was significantly worse in the stress hyperglycemia group than the normoglycemia group with a P value 0.01. The number of mechanically ventilated patients was higher in the stress hyperglycemia group with a significant statistical difference (p 0.05).
And lastly we found that SOFA score was significant higher in the stress hyperglycemia group than in the normoglycemia group (P=0.007).
We concluded that :-
- Stress hyperglycemia is a common phenomenon in critically ill patients, Prevalence of patients with stress hyperglycemia in our study was 113(51.8%) among the studied sample of patients (218).
- Stress hyperglycemia is not a benign condition and its occurrence carries a poor prognosis among critically ill patients as proved by clinical findings, Laboratory parameters, adverse events and mortality.