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Effect of glycemic state on hospital mortality in critically ill surgical patients.
Am Surg. 2011 Nov; 77(11):1483-9.AS

Abstract

Intensive insulin therapy can reduce mortality. Hypoglycemia related to intensive therapy may worsen outcomes. This study compared risk adjusted mortality for different glycemic states. A retrospective review of patients admitted to a surgical intensive care unit over 4 years was performed. Patients were divided into glycemic groups: HYPER (≥1 episode > 180 mg/dL, any <60), HYPO (≥1 episode < 60 mg/dL, any >180), BOTH (≥1 episode < 60 and ≥1 episode > 180 mg/dL), NORMO (all episodes 60-180 mg/dL), HYPER-Only (≥1 episode > 180, none <60 mg/dL), and HYPO-Only (≥1 episode < 60, none >180 mg/dL). Observed to expected Acute Physiology and Chronic Health Evaluation (APACHE) III mortality ratios (O/E) were studied. Number of adverse glycemic events was compared with mortality. Hypoglycemia and hyperglycemia occurred in 18 per cent and 50 per cent of patients. Mortality was 12.4 per cent (O/E = 0.88). BOTH had the highest O/E ratio (1.43) with HYPO the second highest (1.30). Groups excluding hypoglycemia (NORMO and HYPER-only) had the lowest O/E ratios: 0.56 and 0.88. Increasing number of hypoglycemic events were associated with increasing O/E ratio: 0.69 O/E for no events, 1.19 for 1-3 events, 1.35 for 4-6 events, 1.9 for 7-9 events, and 3.13 for ≥ 10 events. Ten or more hyperglycemic events were needed to significantly associate with worse mortality (O/E 1.53). Hyper- and hypoglycemia increase mortality compared with APACHE III expected mortality, with highest mortality risk if both are present. Hypoglycemia is associated with worse risk. Glucose control may need to be loosened to prevent hypoglycemia and reduce glucose variability.

Authors+Show Affiliations

R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22196662

Citation

Chi, Albert, et al. "Effect of Glycemic State On Hospital Mortality in Critically Ill Surgical Patients." The American Surgeon, vol. 77, no. 11, 2011, pp. 1483-9.
Chi A, Lissauer ME, Kirchoffner J, et al. Effect of glycemic state on hospital mortality in critically ill surgical patients. Am Surg. 2011;77(11):1483-9.
Chi, A., Lissauer, M. E., Kirchoffner, J., Scalea, T. M., & Johnson, S. B. (2011). Effect of glycemic state on hospital mortality in critically ill surgical patients. The American Surgeon, 77(11), 1483-9.
Chi A, et al. Effect of Glycemic State On Hospital Mortality in Critically Ill Surgical Patients. Am Surg. 2011;77(11):1483-9. PubMed PMID: 22196662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of glycemic state on hospital mortality in critically ill surgical patients. AU - Chi,Albert, AU - Lissauer,Matthew E, AU - Kirchoffner,Jill, AU - Scalea,Thomas M, AU - Johnson,Steven B, PY - 2011/12/27/entrez PY - 2011/12/27/pubmed PY - 2012/2/22/medline SP - 1483 EP - 9 JF - The American surgeon JO - Am Surg VL - 77 IS - 11 N2 - Intensive insulin therapy can reduce mortality. Hypoglycemia related to intensive therapy may worsen outcomes. This study compared risk adjusted mortality for different glycemic states. A retrospective review of patients admitted to a surgical intensive care unit over 4 years was performed. Patients were divided into glycemic groups: HYPER (≥1 episode > 180 mg/dL, any <60), HYPO (≥1 episode < 60 mg/dL, any >180), BOTH (≥1 episode < 60 and ≥1 episode > 180 mg/dL), NORMO (all episodes 60-180 mg/dL), HYPER-Only (≥1 episode > 180, none <60 mg/dL), and HYPO-Only (≥1 episode < 60, none >180 mg/dL). Observed to expected Acute Physiology and Chronic Health Evaluation (APACHE) III mortality ratios (O/E) were studied. Number of adverse glycemic events was compared with mortality. Hypoglycemia and hyperglycemia occurred in 18 per cent and 50 per cent of patients. Mortality was 12.4 per cent (O/E = 0.88). BOTH had the highest O/E ratio (1.43) with HYPO the second highest (1.30). Groups excluding hypoglycemia (NORMO and HYPER-only) had the lowest O/E ratios: 0.56 and 0.88. Increasing number of hypoglycemic events were associated with increasing O/E ratio: 0.69 O/E for no events, 1.19 for 1-3 events, 1.35 for 4-6 events, 1.9 for 7-9 events, and 3.13 for ≥ 10 events. Ten or more hyperglycemic events were needed to significantly associate with worse mortality (O/E 1.53). Hyper- and hypoglycemia increase mortality compared with APACHE III expected mortality, with highest mortality risk if both are present. Hypoglycemia is associated with worse risk. Glucose control may need to be loosened to prevent hypoglycemia and reduce glucose variability. SN - 1555-9823 UR - https://www.unboundmedicine.com/medline/citation/22196662/Effect_of_glycemic_state_on_hospital_mortality_in_critically_ill_surgical_patients_ L2 - https://journals.sagepub.com/doi/10.1177/000313481107701138?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -