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Glucose control and mortality in critically ill patients.
JAMA. 2003 Oct 15; 290(15):2041-7.JAMA

Abstract

CONTEXT

Hyperglycemia is common in critically ill patients, even in those without diabetes mellitus. Aggressive glycemic control may reduce mortality in this population. However, the relationship between mortality, the control of hyperglycemia, and the administration of exogenous insulin is unclear.

OBJECTIVE

To determine whether blood glucose level or quantity of insulin administered is associated with reduced mortality in critically ill patients.

DESIGN, SETTING, AND PATIENTS

Single-center, prospective, observational study of 531 patients (median age, 64 years) newly admitted over the first 6 months of 2002 to an adult intensive care unit (ICU) in a UK national referral center for cardiorespiratory surgery and medicine.

MAIN OUTCOME MEASURES

The primary end point was intensive care unit (ICU) mortality. Secondary end points were hospital mortality, ICU and hospital length of stay, and predicted threshold glucose level associated with risk of death.

RESULTS

Of 531 patients admitted to the ICU, 523 underwent analysis of their glycemic control. Twenty-four-hour control of blood glucose levels was variable. Rates of ICU and hospital mortality were 5.2% and 5.7%, respectively; median lengths of stay were 1.8 (interquartile range, 0.9-3.7) days and 6 (interquartile range, 4.5-8.3) days, respectively. Multivariable logistic regression demonstrated that increased administration of insulin was positively and significantly associated with ICU mortality (odds ratio, 1.02 [95% confidence interval, 1.01-1.04] at a prevailing glucose level of 111-144 mg/dL [6.1-8.0 mmol/L] for a 1-IU/d increase), suggesting that mortality benefits are attributable to glycemic control rather than increased administration of insulin. Also, the regression models suggest that a mortality benefit accrues below a predicted threshold glucose level of 144 to 200 mg/dL (8.0-11.1 mmol/L), with a speculative upper limit of 145 mg/dL (8.0 mmol/L) for the target blood glucose level.

CONCLUSIONS

Increased insulin administration is positively associated with death in the ICU regardless of the prevailing blood glucose level. Thus, control of glucose levels rather than of absolute levels of exogenous insulin appear to account for the mortality benefit associated with intensive insulin therapy demonstrated by others.

Authors+Show Affiliations

Adult Intensive Care Unit, Royal Brompton Hospital, London, England.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14559958

Citation

Finney, Simon J., et al. "Glucose Control and Mortality in Critically Ill Patients." JAMA, vol. 290, no. 15, 2003, pp. 2041-7.
Finney SJ, Zekveld C, Elia A, et al. Glucose control and mortality in critically ill patients. JAMA. 2003;290(15):2041-7.
Finney, S. J., Zekveld, C., Elia, A., & Evans, T. W. (2003). Glucose control and mortality in critically ill patients. JAMA, 290(15), 2041-7.
Finney SJ, et al. Glucose Control and Mortality in Critically Ill Patients. JAMA. 2003 Oct 15;290(15):2041-7. PubMed PMID: 14559958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucose control and mortality in critically ill patients. AU - Finney,Simon J, AU - Zekveld,Cornelia, AU - Elia,Andi, AU - Evans,Timothy W, PY - 2003/10/16/pubmed PY - 2003/10/24/medline PY - 2003/10/16/entrez SP - 2041 EP - 7 JF - JAMA JO - JAMA VL - 290 IS - 15 N2 - CONTEXT: Hyperglycemia is common in critically ill patients, even in those without diabetes mellitus. Aggressive glycemic control may reduce mortality in this population. However, the relationship between mortality, the control of hyperglycemia, and the administration of exogenous insulin is unclear. OBJECTIVE: To determine whether blood glucose level or quantity of insulin administered is associated with reduced mortality in critically ill patients. DESIGN, SETTING, AND PATIENTS: Single-center, prospective, observational study of 531 patients (median age, 64 years) newly admitted over the first 6 months of 2002 to an adult intensive care unit (ICU) in a UK national referral center for cardiorespiratory surgery and medicine. MAIN OUTCOME MEASURES: The primary end point was intensive care unit (ICU) mortality. Secondary end points were hospital mortality, ICU and hospital length of stay, and predicted threshold glucose level associated with risk of death. RESULTS: Of 531 patients admitted to the ICU, 523 underwent analysis of their glycemic control. Twenty-four-hour control of blood glucose levels was variable. Rates of ICU and hospital mortality were 5.2% and 5.7%, respectively; median lengths of stay were 1.8 (interquartile range, 0.9-3.7) days and 6 (interquartile range, 4.5-8.3) days, respectively. Multivariable logistic regression demonstrated that increased administration of insulin was positively and significantly associated with ICU mortality (odds ratio, 1.02 [95% confidence interval, 1.01-1.04] at a prevailing glucose level of 111-144 mg/dL [6.1-8.0 mmol/L] for a 1-IU/d increase), suggesting that mortality benefits are attributable to glycemic control rather than increased administration of insulin. Also, the regression models suggest that a mortality benefit accrues below a predicted threshold glucose level of 144 to 200 mg/dL (8.0-11.1 mmol/L), with a speculative upper limit of 145 mg/dL (8.0 mmol/L) for the target blood glucose level. CONCLUSIONS: Increased insulin administration is positively associated with death in the ICU regardless of the prevailing blood glucose level. Thus, control of glucose levels rather than of absolute levels of exogenous insulin appear to account for the mortality benefit associated with intensive insulin therapy demonstrated by others. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/14559958/Glucose_control_and_mortality_in_critically_ill_patients_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/290/pg/2041 DB - PRIME DP - Unbound Medicine ER -