Document Detail


Glucose variability is associated with intensive care unit mortality.
MedLine Citation:
PMID:  20035218     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jeroen Hermanides; Titia M Vriesendorp; Robert J Bosman; Durk F Zandstra; Joost B Hoekstra; J Hans Devries
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-19     Completed Date:  2010-03-15     Revised Date:  2011-01-07    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  838-42     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. j.hermanides@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Algorithms
Blood Glucose / metabolism*
Diabetes Mellitus / blood,  drug therapy,  mortality
Female
Hospital Mortality*
Humans
Hypoglycemia / blood,  drug therapy,  mortality
Insulin Infusion Systems
Intensive Care Units*
Male
Middle Aged
Netherlands
Odds Ratio
Predictive Value of Tests
Reference Values
Retrospective Studies
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Blood Glucose
Comments/Corrections
Comment In:
Crit Care Med. 2010 Mar;38(3):993-5   [PMID:  20168161 ]
Crit Care Med. 2011 Jan;39(1):224; author reply 224-5   [PMID:  21178553 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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