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Blood glucose concentration and outcome of critical illness: the impact of diabetes.
Crit Care Med. 2008 Aug; 36(8):2249-55.CC

Abstract

OBJECTIVE

To study the impact of diabetes mellitus on the relationship between glycemia and mortality in critically ill patients.

DESIGN

Retrospective observational study.

SETTING

Intensive care units of two university hospitals.

PATIENTS

Cohort of 4946 critically ill patients including 728 patients with diabetes mellitus.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

We assessed and compared the relationship between glycemia during intensive care unit stay and mortality in diabetic and nondiabetic patients. There were 125,036 blood glucose measurements (5.7 measurements/day on average). Intensive care unit mortality increased significantly with increasing mean blood glucose concentration in nondiabetes mellitus patients but not in diabetes mellitus patients. Nondiabetes mellitus patients with a time-weighted glucose concentration (Glu(Tw)) between 8.0 and 10.0 mmol/L were found to be 1.74 times more likely to die in intensive care unit as diabetes mellitus patients in the same range (odds ratio = 1.74 [1.13-2.68] p = 0.01). They were also more than three times more likely to die in the intensive care unit compared with diabetes mellitus patients when the Glut(w)was between 10.0 and 11.1 mmol/L (odds ratio = 3.34 [1.35-8.23] p = 0.009). Using multivariate logistic regression analysis, hyperglycemia was strongly and independently associated with outcome in nondiabetic patients (p < 0.001) but showed no significant association with outcome in diabetic patients.

CONCLUSIONS

Unlike nondiabetic patients, diabetic patients show no clear association between hyperglycemia during intensive care unit stay and mortality and markedly lower odds ratios of death at all levels of hyperglycemia. These findings suggest that, in critically patients with diabetes mellitus, hyperglycemia may have different biological and/or clinical implications.

Authors+Show Affiliations

Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

18664780

Citation

Egi, Moritoki, et al. "Blood Glucose Concentration and Outcome of Critical Illness: the Impact of Diabetes." Critical Care Medicine, vol. 36, no. 8, 2008, pp. 2249-55.
Egi M, Bellomo R, Stachowski E, et al. Blood glucose concentration and outcome of critical illness: the impact of diabetes. Crit Care Med. 2008;36(8):2249-55.
Egi, M., Bellomo, R., Stachowski, E., French, C. J., Hart, G. K., Hegarty, C., & Bailey, M. (2008). Blood glucose concentration and outcome of critical illness: the impact of diabetes. Critical Care Medicine, 36(8), 2249-55. https://doi.org/10.1097/CCM.0b013e318181039a
Egi M, et al. Blood Glucose Concentration and Outcome of Critical Illness: the Impact of Diabetes. Crit Care Med. 2008;36(8):2249-55. PubMed PMID: 18664780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood glucose concentration and outcome of critical illness: the impact of diabetes. AU - Egi,Moritoki, AU - Bellomo,Rinaldo, AU - Stachowski,Edward, AU - French,Craig J, AU - Hart,Graeme K, AU - Hegarty,Colin, AU - Bailey,Michael, PY - 2008/7/31/pubmed PY - 2008/8/30/medline PY - 2008/7/31/entrez SP - 2249 EP - 55 JF - Critical care medicine JO - Crit Care Med VL - 36 IS - 8 N2 - OBJECTIVE: To study the impact of diabetes mellitus on the relationship between glycemia and mortality in critically ill patients. DESIGN: Retrospective observational study. SETTING: Intensive care units of two university hospitals. PATIENTS: Cohort of 4946 critically ill patients including 728 patients with diabetes mellitus. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We assessed and compared the relationship between glycemia during intensive care unit stay and mortality in diabetic and nondiabetic patients. There were 125,036 blood glucose measurements (5.7 measurements/day on average). Intensive care unit mortality increased significantly with increasing mean blood glucose concentration in nondiabetes mellitus patients but not in diabetes mellitus patients. Nondiabetes mellitus patients with a time-weighted glucose concentration (Glu(Tw)) between 8.0 and 10.0 mmol/L were found to be 1.74 times more likely to die in intensive care unit as diabetes mellitus patients in the same range (odds ratio = 1.74 [1.13-2.68] p = 0.01). They were also more than three times more likely to die in the intensive care unit compared with diabetes mellitus patients when the Glut(w)was between 10.0 and 11.1 mmol/L (odds ratio = 3.34 [1.35-8.23] p = 0.009). Using multivariate logistic regression analysis, hyperglycemia was strongly and independently associated with outcome in nondiabetic patients (p < 0.001) but showed no significant association with outcome in diabetic patients. CONCLUSIONS: Unlike nondiabetic patients, diabetic patients show no clear association between hyperglycemia during intensive care unit stay and mortality and markedly lower odds ratios of death at all levels of hyperglycemia. These findings suggest that, in critically patients with diabetes mellitus, hyperglycemia may have different biological and/or clinical implications. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/18664780/Blood_glucose_concentration_and_outcome_of_critical_illness:_the_impact_of_diabetes_ L2 - https://dx.doi.org/10.1097/CCM.0b013e318181039a DB - PRIME DP - Unbound Medicine ER -