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Glucose variability is associated with intensive care unit mortality.
Crit Care Med. 2010 Mar; 38(3):838-42.CC

Abstract

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+Show Affiliations

Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. j.hermanides@amc.uva.nlNo 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

20035218

Citation

Hermanides, Jeroen, et al. "Glucose Variability Is Associated With Intensive Care Unit Mortality." Critical Care Medicine, vol. 38, no. 3, 2010, pp. 838-42.
Hermanides J, Vriesendorp TM, Bosman RJ, et al. Glucose variability is associated with intensive care unit mortality. Crit Care Med. 2010;38(3):838-42.
Hermanides, J., Vriesendorp, T. M., Bosman, R. J., Zandstra, D. F., Hoekstra, J. B., & Devries, J. H. (2010). Glucose variability is associated with intensive care unit mortality. Critical Care Medicine, 38(3), 838-42. https://doi.org/10.1097/CCM.0b013e3181cc4be9
Hermanides J, et al. Glucose Variability Is Associated With Intensive Care Unit Mortality. Crit Care Med. 2010;38(3):838-42. PubMed PMID: 20035218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucose variability is associated with intensive care unit mortality. AU - Hermanides,Jeroen, AU - Vriesendorp,Titia M, AU - Bosman,Robert J, AU - Zandstra,Durk F, AU - Hoekstra,Joost B, AU - Devries,J Hans, PY - 2009/12/26/entrez PY - 2009/12/26/pubmed PY - 2010/3/17/medline SP - 838 EP - 42 JF - Critical care medicine JO - Crit Care Med VL - 38 IS - 3 N2 - 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. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/20035218/Glucose_variability_is_associated_with_intensive_care_unit_mortality_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181cc4be9 DB - PRIME DP - Unbound Medicine ER -