The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study

Sigrid C Van Steen,Saskia Rijkenberg,J Hans Devries,Peter H J Van Der Voort

doi:10.1186/s13613-019-0507-x

Abstract

BackgroundWe assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality.MethodsFor this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 2017. We excluded patients admitted < 24 h, patients with a diabetic ketoacidosis, patients with a therapy restriction upon ICU admission and readmissions. Using multivariate logistic regression, we examined the relation between intravenous insulin and glucose infusion and ICU and hospital mortality for all patients. Additionally, we used the same model to analyze the outcomes for patients admitted > 72 h.ResultsOf 9507 eligible patients, 3966 were included. After correction for potential confounders, intravenous insulin was associated with ICU and hospital mortality in patients admitted > 24 h (n = 3966) (odds ratio (OR) 1.09 [95% CI 1.05–1.13] and 1.09 [95% CI 1.06–1.13] per 0.1 IU/kg added, respectively). Likewise, intravenous glucose was associated with ICU mortality (OR 1.01 [95% CI 1.00–1.01]) but not with hospital mortality and (OR 1.00 [95% CI 1.00–1.01]) per g/day added, respectively. In patients admitted > 72 h (n = 1550), insulin dose was associated with both ICU and hospital mortality (p = 0.002 and p < 0.001, respectively), but glucose infusion was not (p = 0.08 and p = 0.2, respectively).ConclusionsIntravenous insulin administration is associated with an increased risk of ICU and hospital mortality, after correction for potential confounders. Parenteral glucose administration was limited in amount but was still associated with ICU mortality. However, based on these results, it is unknown whether this association is an epiphenomenon, or represents a true harm of insulin and glucose administration.

Highlights

We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality
Over 20% of the patients had a history of diabetes, and half of these patients previously used insulin
We found no interaction between insulin and glucose infusion on ICU mortality

Summary

Introduction

We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality. The insulin resistance is characterized by a disproportionate hepatic glucose production, diminished muscular glucose uptake and increased lipolysis [5] This hyperglycemia is associated with increased morbidity and Intravenous rapidly acting insulin is a highly effective glucose lowering drug and the standard treatment van Steen et al Ann. Intensive Care (2019) 9:29 modality for hyperglycemia in the ICU [14]. Studies on insulin use in the ICU have focused mainly on the effect of insulin therapy with tight as compared to more liberal glucose targets [15,16,17,18,19,20,21,22]. Current ICU guidelines recommend that insulin should be used to achieve intermediate BG targets [25, 26]

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