Abstract
Introduction: In-ICU glycemic variability (GV) is associated with increased mortality (M). However, its effect on survivors’ morbidity and associated changes in disposition at hospital discharge is unknown. Hypothesis: Increasing GV reduces rates of home discharge among survivors of critical illness. Methods: We studied a retrospective patient cohort in a Med/Surg ICU, requiring insulin infusion, targeting blood glucose (BG) 90-130 mg/dl, using computer-guided insulin dosing (CG) [GlucoStabilizer™] between 3/1/08-6/30/09. Exclusions were age <18 yrs, <10 BG values, diabetic ketoacidosis/hyperglycemic hyperosmolar state, hospital readmission, & in-hospital mortality. GV was defined as standard deviation of the means of each patient’s BG (BGave). We examined rates of routine home discharge (H) across GV quartiles, between patients with and without H, and determinants of H. Chi-square test for trend, Mann-Whitney rank-sum test, and stepwise multivariate regression modeling were used, as appropriate. Results: Three hundred forty one patients met study criteria (overall M 19.9%). Patients had mean (SD) age 58.3 (15.4) yrs; 56% were male; 42% Hispanic; 57% had diabetes; median (IQR) ICU LOS was 4.8 (2.8-9.3) days; mean (SD) BGave 125.2 (24.5) mg/dl. Median (IQR) GV was 31.3 (24.9-47.6) mg/dl. Rates of H increased with GV quartile (p = 0.0018). The OR for H among survivors in the highest vs. lowest GV quartiles was 2.8 (95% CI 1.5-5.2; p = 0.0011). GV was higher in patients with H than non-H (36.1 vs. 30.0 mg/dl, respectively; p = 0.002). Finally, GV was not a predictor of H on multivariate analysis. Conclusions: Contrary to expectations, GV was directly associated with home discharge among survivors of critical illness in the present cohort. The odds of routine home discharge were 280% higher among patients in the highest vs. lowest GV quartiles, suggesting lower residual morbidity in the former. The generalizability of these findings needs further examination in other patient populations, CGs, and glycemic targets.
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