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Glycemic variability: a strong independent predictor of mortality in critically ill patients.
Crit Care Med. 2008 Nov; 36(11):3008-13.CC

Abstract

OBJECTIVES

To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients.

DESIGN

Retrospective review of a large cohort of prospectively evaluated patients.

SETTING

Fourteen-bed medical surgical adult intensive care unit of a university affiliated community hospital.

PATIENTS

Three thousand two hundred fifty-two patients consecutively admitted between October 1999 and October 2007 with at least three venous glucose samples.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The mean (sd) Acute Physiology and Chronic Health Evaluation II score of the 3252 patients was 20.0 (8.9) and their mortality was 24.4%, ranging from 18.1% among patients with mean glucose level 70 mg/dL to 99 mg/dL to 35.9% among patients with mean glucose level 180+ mg/dL. The relationship between glycemic variability and mortality was strongest in the euglycemic range. For the 410 patients with mean glucose level 70 mg/dL to 99 mg/dL, mortality ranged from 5.9% in the first quartile of glycemic variability to 30.1% in the fourth; for the 1031 patients with mean glucose level 100 mg/dL to 119 mg/dL the corresponding range was 9.7% to 31.0%. Mortality among patients in the entire cohort with the lowest quartile of glycemic variability was 12.1%, increasing to 19.9%, 27.7%, and 37.8% in the second, third, and fourth quartiles. Intensive care unit length of stay was shorter among patients in the first quartile compared with those in the other three (p < .001).

CONCLUSIONS

This study demonstrates that increasing glycemic variability conferred a strong independent risk of mortality in this heterogeneous population of critically ill patients. Previously published interventional studies of glycemic control may be reinterpreted using the metric of glycemic variability. Measures to ensure a low degree of glycemic variability may improve outcomes in intensive care unit's implementing glycemic control. Finally, ongoing and future investigations should consider including this new metric in their study design.

Authors+Show Affiliations

Stamford Hospital, Columbia University College of Physicians and Surgeons, Stamford, CT, USA. jkrinsley@stamhealth.org

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18824908

Citation

Krinsley, James S.. "Glycemic Variability: a Strong Independent Predictor of Mortality in Critically Ill Patients." Critical Care Medicine, vol. 36, no. 11, 2008, pp. 3008-13.
Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med. 2008;36(11):3008-13.
Krinsley, J. S. (2008). Glycemic variability: a strong independent predictor of mortality in critically ill patients. Critical Care Medicine, 36(11), 3008-13. https://doi.org/10.1097/CCM.0b013e31818b38d2
Krinsley JS. Glycemic Variability: a Strong Independent Predictor of Mortality in Critically Ill Patients. Crit Care Med. 2008;36(11):3008-13. PubMed PMID: 18824908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glycemic variability: a strong independent predictor of mortality in critically ill patients. A1 - Krinsley,James S, PY - 2008/10/1/pubmed PY - 2008/11/18/medline PY - 2008/10/1/entrez SP - 3008 EP - 13 JF - Critical care medicine JO - Crit Care Med VL - 36 IS - 11 N2 - OBJECTIVES: To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients. DESIGN: Retrospective review of a large cohort of prospectively evaluated patients. SETTING: Fourteen-bed medical surgical adult intensive care unit of a university affiliated community hospital. PATIENTS: Three thousand two hundred fifty-two patients consecutively admitted between October 1999 and October 2007 with at least three venous glucose samples. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mean (sd) Acute Physiology and Chronic Health Evaluation II score of the 3252 patients was 20.0 (8.9) and their mortality was 24.4%, ranging from 18.1% among patients with mean glucose level 70 mg/dL to 99 mg/dL to 35.9% among patients with mean glucose level 180+ mg/dL. The relationship between glycemic variability and mortality was strongest in the euglycemic range. For the 410 patients with mean glucose level 70 mg/dL to 99 mg/dL, mortality ranged from 5.9% in the first quartile of glycemic variability to 30.1% in the fourth; for the 1031 patients with mean glucose level 100 mg/dL to 119 mg/dL the corresponding range was 9.7% to 31.0%. Mortality among patients in the entire cohort with the lowest quartile of glycemic variability was 12.1%, increasing to 19.9%, 27.7%, and 37.8% in the second, third, and fourth quartiles. Intensive care unit length of stay was shorter among patients in the first quartile compared with those in the other three (p < .001). CONCLUSIONS: This study demonstrates that increasing glycemic variability conferred a strong independent risk of mortality in this heterogeneous population of critically ill patients. Previously published interventional studies of glycemic control may be reinterpreted using the metric of glycemic variability. Measures to ensure a low degree of glycemic variability may improve outcomes in intensive care unit's implementing glycemic control. Finally, ongoing and future investigations should consider including this new metric in their study design. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/18824908/Glycemic_variability:_a_strong_independent_predictor_of_mortality_in_critically_ill_patients_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31818b38d2 DB - PRIME DP - Unbound Medicine ER -