Abstract
BackgroundWe retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients.Methods‘Glycemic variability’ and ‘insulin infusion rate variability’ were calculated from and expressed as the standard deviation (SD) of all blood glucose levels and insulin infusion rates during stay in the ICU, respectively. Glycemic and insulin infusion rate variability in patients who received bolus infusion of hydrocortisone were compared to those in patients who never received bolus infusion of hydrocortisone. Multivariate analysis was performed to correct for potential covariates including disease severity.ResultsWe included 6409 patients over 6 years; of them 962 received bolus infusion of hydrocortisone. Compared to patients who never received bolus infusion of hydrocortisone, patients who received hydrocortisone had their blood glucose level measured more frequently, had higher glycemic variability; were more frequently treated with intravenous insulin and had higher insulin infusion rate variability. The association between hydrocortisone treatment and glycemic variability was independent of disease severity, but the effect of hydrocortisone treatment on blood glucose variability was less strong in the more severely ill patients. The association between hydrocortisone and insulin infusion rate variability was also independent of disease severity, and independent of glycemic variability.ConclusionsBolus infusion of hydrocortisone is independently associated with higher glycemic variability and higher insulin infusion rate variability in ICU patients. Studies are needed to see if continuous infusion of hydrocortisone prevents higher glycemic variability and higher insulin infusion rate variability.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0077-5) contains supplementary material, which is available to authorized users.
Highlights
We retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients
In a cohort of patients receiving blood glucose control aiming at blood glucose levels between 90 and 144 mg/dL, we tested the two following hypotheses: (a) bolus infusion of hydrocortisone is associated with glycemic variability, and (b) bolus infusion of hydrocortisone is associated with insulin infusion rate variability
Patients treated with hydrocortisone were older, more severely ill according to Acute Physiology and Chronic Health Evaluation (APACHE) II scores, more often non-surgical patients and died more frequently
Summary
We retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients. Could induce short episodes of hyperglycemia frequently requiring temporary van Hooijdonk et al Ann. Intensive Care (2015) 5:34. Glycemic variability is associated with increased mortality in critically ill patients [6]. It is unknown to what extent bolus infusion of hydrocortisone increases glycemic variability and adjustments in insulin infusion rates in patients under moderate glycemic control. In a cohort of patients receiving blood glucose control aiming at blood glucose levels between 90 and 144 mg/dL, we tested the two following hypotheses: (a) bolus infusion of hydrocortisone is associated with glycemic variability, and (b) bolus infusion of hydrocortisone is associated with insulin infusion rate variability
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