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Mild hypoglycemia is independently associated with increased mortality in the critically ill.
Crit Care. 2011 Jul 25; 15(4):R173.CC

Abstract

INTRODUCTION

Severe hypoglycemia (blood glucose concentration (BG) < 40 mg/dL) is independently associated with an increased risk of mortality in critically ill patients. The association of milder hypoglycemia (BG < 70 mg/dL) with mortality is less clear.

METHODS

Prospectively collected data from two observational cohorts in the USA and in The Netherlands, and from the prospective GLUCONTROL trial were analyzed. Hospital mortality was the primary endpoint.

RESULTS

We analyzed data from 6,240 patients: 3,263 admitted to Stamford Hospital (ST), 2,063 admitted to three institutions in The Netherlands (NL) and 914 who participated in the GLUCONTROL trial (GL). The percentage of patients with hypoglycemia varied from 18% to 65% among the different cohorts. Patients with hypoglycemia experienced higher mortality than did those without hypoglycemia even after stratification by severity of illness, diagnostic category, diabetic status, mean BG during intensive care unit (ICU) admission and coefficient of variation (CV) as a reflection of glycemic variability. The relative risk (RR, 95% confidence interval) of mortality associated with minimum BG < 40, 40 to 54 and 55 to 69 mg/dL compared to patients with minimum BG 80 to 109 mg/dL was 3.55 (3.02 to 4.17), 2.70 (2.31 to 3.14) and 2.18 (1.87 to 2.53), respectively (all P < 0.0001). The RR of mortality associated with any hypoglycemia < 70 mg/dL was 3.28 (2.78 to 3.87) (P < 0.0001), 1.30 (1.12 to 1.50) (P = 0.0005) and 2.11 (1.62 to 2.74) (P < 0.0001) for the ST, NL and GL cohorts, respectively. Multivariate regression analysis demonstrated that minimum BG < 70 mg/dL, 40 to 69 mg/dL and < 40 mg/dL were independently associated with increased risk of mortality for the entire cohort of 6,240 patients (odds ratio (OR) (95% confidence interval (CI)) 1.78 (1.39 to 2.27) P < 0.0001), 1.29 (1.11 to 1.51) P = 0.0011 and 1.87 (1.46 to 2.40) P < 0.0001) respectively.

CONCLUSIONS

Mild hypoglycemia was associated with a significantly increased risk of mortality in an international cohort of critically ill patients. Efforts to reduce the occurrence of hypoglycemia in critically ill patients may reduce mortality.

Authors+Show Affiliations

Division of Critical Care, Stamford Hospital, Columbia University College of Physicians and Surgeons, 190 West Broad Street, Stamford, CT 06902, USA. james.krinsley@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21787410

Citation

Krinsley, James S., et al. "Mild Hypoglycemia Is Independently Associated With Increased Mortality in the Critically Ill." Critical Care (London, England), vol. 15, no. 4, 2011, pp. R173.
Krinsley JS, Schultz MJ, Spronk PE, et al. Mild hypoglycemia is independently associated with increased mortality in the critically ill. Crit Care. 2011;15(4):R173.
Krinsley, J. S., Schultz, M. J., Spronk, P. E., Harmsen, R. E., van Braam Houckgeest, F., van der Sluijs, J. P., Mélot, C., & Preiser, J. C. (2011). Mild hypoglycemia is independently associated with increased mortality in the critically ill. Critical Care (London, England), 15(4), R173. https://doi.org/10.1186/cc10322
Krinsley JS, et al. Mild Hypoglycemia Is Independently Associated With Increased Mortality in the Critically Ill. Crit Care. 2011 Jul 25;15(4):R173. PubMed PMID: 21787410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mild hypoglycemia is independently associated with increased mortality in the critically ill. AU - Krinsley,James S, AU - Schultz,Marcus J, AU - Spronk,Peter E, AU - Harmsen,Robin E, AU - van Braam Houckgeest,Floris, AU - van der Sluijs,Johannes P, AU - Mélot,Christian, AU - Preiser,Jean Charles, Y1 - 2011/07/25/ PY - 2011/02/09/received PY - 2011/06/17/revised PY - 2011/07/25/accepted PY - 2011/7/27/entrez PY - 2011/7/27/pubmed PY - 2012/8/22/medline SP - R173 EP - R173 JF - Critical care (London, England) JO - Crit Care VL - 15 IS - 4 N2 - INTRODUCTION: Severe hypoglycemia (blood glucose concentration (BG) < 40 mg/dL) is independently associated with an increased risk of mortality in critically ill patients. The association of milder hypoglycemia (BG < 70 mg/dL) with mortality is less clear. METHODS: Prospectively collected data from two observational cohorts in the USA and in The Netherlands, and from the prospective GLUCONTROL trial were analyzed. Hospital mortality was the primary endpoint. RESULTS: We analyzed data from 6,240 patients: 3,263 admitted to Stamford Hospital (ST), 2,063 admitted to three institutions in The Netherlands (NL) and 914 who participated in the GLUCONTROL trial (GL). The percentage of patients with hypoglycemia varied from 18% to 65% among the different cohorts. Patients with hypoglycemia experienced higher mortality than did those without hypoglycemia even after stratification by severity of illness, diagnostic category, diabetic status, mean BG during intensive care unit (ICU) admission and coefficient of variation (CV) as a reflection of glycemic variability. The relative risk (RR, 95% confidence interval) of mortality associated with minimum BG < 40, 40 to 54 and 55 to 69 mg/dL compared to patients with minimum BG 80 to 109 mg/dL was 3.55 (3.02 to 4.17), 2.70 (2.31 to 3.14) and 2.18 (1.87 to 2.53), respectively (all P < 0.0001). The RR of mortality associated with any hypoglycemia < 70 mg/dL was 3.28 (2.78 to 3.87) (P < 0.0001), 1.30 (1.12 to 1.50) (P = 0.0005) and 2.11 (1.62 to 2.74) (P < 0.0001) for the ST, NL and GL cohorts, respectively. Multivariate regression analysis demonstrated that minimum BG < 70 mg/dL, 40 to 69 mg/dL and < 40 mg/dL were independently associated with increased risk of mortality for the entire cohort of 6,240 patients (odds ratio (OR) (95% confidence interval (CI)) 1.78 (1.39 to 2.27) P < 0.0001), 1.29 (1.11 to 1.51) P = 0.0011 and 1.87 (1.46 to 2.40) P < 0.0001) respectively. CONCLUSIONS: Mild hypoglycemia was associated with a significantly increased risk of mortality in an international cohort of critically ill patients. Efforts to reduce the occurrence of hypoglycemia in critically ill patients may reduce mortality. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/21787410/Mild_hypoglycemia_is_independently_associated_with_increased_mortality_in_the_critically_ill_ DB - PRIME DP - Unbound Medicine ER -