A systematic scoping review on the consequences of stress-related hyperglycaemia

PLoS One. 2018 Apr 6;13(4):e0194952. doi: 10.1371/journal.pone.0194952. eCollection 2018.


Background: Stress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed.

Methods: We conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness.

Results: The search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.

Discussion: SHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Glucose
  • Critical Illness
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / epidemiology
  • Hyperglycemia / etiology*
  • Hyperglycemia / mortality
  • Intensive Care Units
  • Length of Stay
  • Stress, Physiological*
  • Stress, Psychological*
  • Wounds and Injuries / complications


  • Blood Glucose

Grant support

PHMR was commissioned by Nestlé Health Science to perform this research. In collaboration with Nestlé Health Science, PHMR wrote the scoping review’s protocol, designed the search strategy and eligibility criteria, performed the study selection, charted the data and summarised the results. A protocol was not registered for this systematic scoping review as PROSPERO currently does not accept systematic scoping review protocols (personal communication). All authors had full access to the data. All authors had final responsibility for the decision to submit for publication. At the time of writing, EO and NP were permanent employees of PHMR; AD and MM are permanent employees of Nestlé Health Science; J-CP has received honoraria for speeches and consultancy fees from Nestlé (Vevey, Switzerland).