Abstract
Background This retrospective study aimed to determine the correlation of blood glucose and glycemic variability with mortality and to identify the strongest glycemic variability parameter for predicting mortality in critically ill patients. Methods A total of 528 patients admitted to the medical intensive care unit were included in this study. Blood glucose levels during the first 24 hours of admission were recorded and calculated to determine the glycemic variability. Significant glycemic variability parameters, including the standard deviation, coefficient of variation, maximal blood glucose difference, and J-index, were subsequently compared between intensive care unit survivors and nonsurvivors. A binary logistic regression was performed to identify independent factors associated with mortality. To determine the strongest glycemic variability parameter to predict mortality, the area under the receiver operating characteristic of each glycemic variability parameter was determined, and a pairwise comparison was performed. Results Among the 528 patients, 17.8% (96/528) were nonsurvivors. Both survivor and nonsurvivor groups were clinically comparable. However, nonsurvivors had significantly higher median APACHE-II scores (23 [21, 27] vs. 18 [14, 22]; p < 0.01) and a higher mechanical ventilator support rate (97.4% vs. 74.9%; p < 0.01). The mean blood glucose level and significant glycemic variability parameters were higher in nonsurvivors than in survivors. The maximal blood glucose difference yielded a similar power to the coefficient of variation (p = 0.21) but was significantly stronger than the standard deviation (p = 0.005) and J-index (p = 0.006). Conclusions Glycemic variability was independently associated with intensive care unit mortality. Higher glycemic variability was identified in the nonsurvivor group regardless of preexisting diabetes mellitus. The maximal blood glucose difference and coefficient of variation of the blood glucose were the two strongest parameters for predicting intensive care unit mortality in this study.
Highlights
Acute hyperglycemia or stress-induced hyperglycemia in critically ill patients commonly occurs in the intensive care unit (ICU) [1]. is glycemic alteration is theoretically caused by the stimulation of the counter-regulatory hormones, which primarily respond to inflammation and insulin receptor resistance [1,2,3,4,5,6]. is abnormal elevation of blood glucose level was essentially related to adverse outcomes in critically ill patients including mortality, acute kidney injury development, nosocomial infection, and peripheral neuropathy [7,8,9,10,11,12,13]
We found that the group of patients with low maximal blood glucose difference (MGD) had a lower ICU mortality rate compared with the patients with a higher MGD regardless of blood glucose level, similar to a previous retrospective study [40]. ese concordant results support the observation that the target of glycemic control in stress hyperglycemia should be to optimize the absolute blood glucose level but should be to reduce glycemic variability (GV)
GV was independently associated with ICU mortality
Summary
Acute hyperglycemia or stress-induced hyperglycemia in critically ill patients commonly occurs in the intensive care unit (ICU) [1]. is glycemic alteration is theoretically caused by the stimulation of the counter-regulatory hormones, which primarily respond to inflammation and insulin receptor resistance [1,2,3,4,5,6]. is abnormal elevation of blood glucose level was essentially related to adverse outcomes in critically ill patients including mortality, acute kidney injury development, nosocomial infection, and peripheral neuropathy [7,8,9,10,11,12,13].Intensive blood glucose control in critically ill patients, to keep the blood glucose level at 80–110 mg/dL by continuous insulin infusion, significantly reduced ICU mortality and morbidity. Acute hyperglycemia or stress-induced hyperglycemia in critically ill patients commonly occurs in the intensive care unit (ICU) [1]. Is abnormal elevation of blood glucose level was essentially related to adverse outcomes in critically ill patients including mortality, acute kidney injury development, nosocomial infection, and peripheral neuropathy [7,8,9,10,11,12,13]. Intensive blood glucose control in critically ill patients, to keep the blood glucose level at 80–110 mg/dL by continuous insulin infusion, significantly reduced ICU mortality and morbidity. A NICE SUGAR trial recently demonstrated the appropriated blood glucose level control in critically ill patients at 140–180 mg/dL, resulting in lower occurrence of hypoglycemic complication but without significant difference in ICU mortality [18, 19]. Blood glucose levels have been generally used as a biomarker for glycemic target in the general ICU care worldwide.
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