Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis: a 3-year retrospective observational study
Open Access
- 1 January 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 16 (5), R189
- https://doi.org/10.1186/cc11674
Abstract
Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited. Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated. Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6%) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7%) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9%) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2% vs. 15.6%, P = 0.003; cardiac, 31.9% vs. 14.3%, P = 0.008; hepatic, 34.0% vs. 18.2%, P = 0.024; bacteremia, 14.9% vs. 4.5%, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95% confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95% confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001). Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.Keywords
This publication has 31 references indexed in Scilit:
- The impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patientsCurrent Opinion in Clinical Nutrition and Metabolic Care, 2012
- Recommendations for sepsis management in resource-limited settingsIntensive Care Medicine, 2012
- Mild hypoglycemia is independently associated with increased mortality in the critically illCritical Care, 2011
- Hypoglycemia and Outcome in Critically Ill PatientsMayo Clinic Proceedings, 2010
- Standards of Medical Care in Diabetes—2010Diabetes Care, 2010
- Intensive versus Conventional Glucose Control in Critically Ill PatientsThe New England Journal of Medicine, 2009
- Glucose variability and mortality in patients with sepsis*Critical Care Medicine, 2008
- Hypoglycemia Increases Serum Interleukin-6 Levels in Healthy Men and WomenDiabetes Care, 2008
- The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variabilityCritical Care, 2008
- Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhageCritical Care, 2008