Glucose variability is associated with intensive care unit mortality*
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- 1 March 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 38 (3), 838-842
- https://doi.org/10.1097/ccm.0b013e3181cc4be9
Abstract
Objective: Mounting evidence suggests a role for glucose variability in predicting intensive care unit (ICU) mortality. We investigated the association between glucose variability and intensive care unit and in-hospital deaths across several ranges of mean glucose. Design: Retrospective cohort study. Setting: An 18-bed medical/surgical ICU in a teaching hospital. Patients: All patients admitted to the ICU from January 2004 through December 2007. Interventions: None. Measurements and Main Results: Two measures of variability, mean absolute glucose change per hour and SD, were calculated as measures of glucose variability from 5728 patients and were related to ICU and in-hospital death using logistic regression analysis. Mortality rates and adjusted odds ratios for ICU death per mean absolute glucose change per hour quartile across quartiles of mean glucose were calculated. Patients were treated with a computerized insulin algorithm (target glucose 72-126 mg/dL). Mean age was 65 +/- 13 yrs, 34% were female, and 6.3% of patients died in the ICU. The odds ratios for ICU death were higher for quartiles of mean absolute glucose change per hour compared with quartiles of mean glucose or SD. The highest odds ratio for ICU death was found in patients with the highest mean absolute glucose change per hour in the upper glucose quartile: odds ratio 12.4 (95% confidence interval, 3.2-47.9; p<.001). Mortality rates were lowest in the lowest mean absolute glucose change per hour quartiles. Conclusions: High glucose variability is firmly associated with ICU and in-hospital death. High glucose variability combined with high mean glucose values is associated with highest ICU mortality. In patients treated with strict glycemic control, low glucose variability seemed protective, even when mean glucose levels remained elevated. (Crit Care Med 2010; 38: 838-842)This publication has 37 references indexed in Scilit:
- Intensive versus Conventional Glucose Control in Critically Ill PatientsThe New England Journal of Medicine, 2009
- The impact of early hypoglycemia and blood glucose variability on outcome in critical illnessCritical Care, 2009
- Predicting Outcomes for Cardiac Surgery Patients After Intensive Care Unit AdmissionSeminars in Cardiothoracic and Vascular Anesthesia, 2008
- Oscillating Glucose Is More Deleterious to Endothelial Function and Oxidative Stress Than Mean Glucose in Normal and Type 2 Diabetic PatientsDiabetes, 2008
- Association of Blood Glucose With Angiographic and Clinical Outcomes Among Patients With ST-Segment Elevation Myocardial Infarction (from the CLARITY-TIMI-28 Study)The American Journal of Cardiology, 2008
- The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variabilityCritical Care, 2008
- Tight blood glucose control: What is the evidence?Critical Care Medicine, 2007
- Hypoglycemic neuronal death is triggered by glucose reperfusion and activation of neuronal NADPH oxidaseJCI Insight, 2007
- Intensive Insulin Therapy in the Medical ICUThe New England Journal of Medicine, 2006
- APACHE IICritical Care Medicine, 1985