Hypoglycemia at admission is associated with inhospital mortality in Ugandan patients with severe sepsis*
- 1 October 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 39 (10), 2271-2276
- https://doi.org/10.1097/ccm.0b013e3182227bd2
Abstract
Dysglycemia during sepsis is associated with poor outcomes in resource-rich settings. In resource-limited settings, hypoglycemia is often diagnosed clinically without the benefit of laboratory support. We studied the utility of point-of-care glucose monitoring to predict mortality in severely septic patients in Uganda. Prospective observational study. One national and two regional referral hospitals in Uganda. We enrolled 532 patients with sepsis at three hospitals in Uganda. The analysis included 418 patients from the three sites with inhospital mortality data, a documented admission blood glucose concentration, and evidence of organ dysfunction at admission (systolic blood pressure ≤100 mm Hg, lactate >4 mmol/L, platelet number <100,000/μL, or altered mental status). None. We evaluated the association between admission point-of-care blood glucose concentration and inhospital mortality. We also assessed the accuracy of altered mental status as a predictor of hypoglycemia. Euglycemia occurred in 33.5% (140 of 418) of patients, whereas 16.3% (68 of 418) of patients were hypoglycemic and 50.2% (210 of 418) were hyperglycemic. Univariate Cox regression analyses comparing in-hospital mortality among hypoglycemic (35.3% [24 of 68], hazard ratio 2.0, 95% confidence interval 1.2–3.6, p = .013) and hyperglycemic (29.5% [62 of 210], hazard ratio 1.5, 95% confidence interval 0.96–2.4, p = .08) patients to euglycemic (19.3% [27 of 140]) patients showed statistically significantly higher rates of inhospital mortality for patients with hypoglycemia. Hypoglycemia (adjusted hazard ratio 1.9, 95% confidence interval 1.1–3.3, p = .03) remained significantly and independently associated with inhospital mortality in the multivariate model. The sensitivity and specificity of altered mental status for hypoglycemia were 25% and 86%, respectively. Hypoglycemia is an independent risk factor for inhospital mortality in patients with severe sepsis and cannot be adequately assessed by clinical examination. Correction of hypoglycemia may improve outcomes of critically ill patients in resource-limited settings.This publication has 28 references indexed in Scilit:
- Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providersCritical Care, 2011
- Hypoglycemia is associated with intensive care unit mortality*Critical Care Medicine, 2010
- Hypoglycemia and Outcome in Critically Ill PatientsMayo Clinic Proceedings, 2010
- Severe Sepsis in Two Ugandan Hospitals: a Prospective Observational Study of Management and Outcomes in a Predominantly HIV-1 Infected PopulationPLOS ONE, 2009
- Accuracy of AccuChek glucose measurement in intensive care patients*Critical Care Medicine, 2009
- The impact of early hypoglycemia and blood glucose variability on outcome in critical illnessCritical Care, 2009
- Accuracy of bedside glucose measurement from three glucometers in critically ill patients*Critical Care Medicine, 2008
- Strategies to Reduce Mortality from Bacterial Sepsis in Adults in Developing CountriesPLoS Medicine, 2008
- The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variabilityCritical Care, 2008
- Hypoglycemia: Causes, neurological manifestations, and outcomeAnnals of Neurology, 1985