The online version of this article (doi:10.1186/cc10322) contains supplementary material, which is available to authorized users.
James S. Krinsley MD has performed consulting work for Medtronic Inc., Edwards Life Sciences, Baxter, Roche Diagnostics, and Optiscan Biomedical and has received speaker's fees from Edwards Life Sciences, Roche Diagnostics and Sanofi to Aventis. Marcus J. Schultz MD, PhD has performed consulting work for Medtronic Inc., Roche Diagnostics and Optiscan Biomedical, and has received research support from Optiscan Biomedical. Jean-Charles Preiser MD, PhD has performed consulting work for Medtronic Inc., Edwards Life Sciences and Optiscan Biomedical. All other authors have no competing interests.
JSK wrote the initial and subsequent drafts of the manuscript and performed statistical analysis. MJS and JCP reviewed all drafts of the manuscript and assisted with revisions. PES, REH, FvBH, JPvdS and CM participated in data acquisition and reviewed the final draft of the manuscript. All authors have read and approved the final manuscript for publication.
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.
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.
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.
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
Additional file 1: Stamford Hospital glycemic management protocol. (DOC 46 KB)13054_2011_9619_MOESM1_ESM.DOC
Additional file 2: GLUCONTROL trial glycemic management protocols. (DOC 54 KB)13054_2011_9619_MOESM2_ESM.DOC
Authors’ original file for figure 113054_2011_9619_MOESM3_ESM.jpeg
Authors’ original file for figure 213054_2011_9619_MOESM4_ESM.jpeg
Authors’ original file for figure 313054_2011_9619_MOESM5_ESM.jpeg
Authors’ original file for figure 413054_2011_9619_MOESM6_ESM.jpeg
Authors’ original file for figure 513054_2011_9619_MOESM7_ESM.jpeg
Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, GruendLing M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K: Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Eng J Med 2008, 358: 125-139. 10.1056/NEJMoa070716 CrossRef
Preiser JC, Devos P, Ruiz-Santana S, Melot C, Annane D, Groeneveld J, Iapichino G, Leverve X, Nitenberg G, Singer P, Wernerman J, Joannidis M, Stecher A, Chiolero R: A prospective randomized multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the GLUCONTROL study. Intensive Care Med 2009, 35: 1738-1748. 10.1007/s00134-009-1585-2 PubMedCrossRef
NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ: Intensive versus conventional glucose control in critically ill patients. N Eng J Med 2009, 360: 1283-1297. CrossRef
Meyfroidt G, Keenan DM, Wang X, Wouters P, Veldhuis J, Van den Berghe G: Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality. Crit Care Med 2010, 38: 1021-1029. 10.1097/CCM.0b013e3181cf710e PubMedCrossRef
Aragon D: Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control. Am J Crit Care 2006, 15: 370-377. PubMed
Oddo M, Schmidt JM, Carrerra E, Badjatia N, Connolly E, Presciutti M, Ostapkovich N, Levine J, Roux P, Mayer S: Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: A microdialysis study. Crit Care Med 2008, 36: 3233-3238. 10.1097/CCM.0b013e31818f4026 PubMedCrossRef
Siegelaar SE, Hermanides J, Oudemans-van Straaten HM, van der Voort PHJ, Bosman RJ, Zandstra DF, DeVries JH: Mean glucose during ICU admission is related-mortality by a U-shaped curve in surgical and medical patients: a retrospective cohort study. Crit Care 2010, 14: R224. 10.1186/cc9369 PubMedPubMedCentralCrossRef
- Mild hypoglycemia is independently associated with increased mortality in the critically ill
James S Krinsley
Marcus J Schultz
Peter E Spronk
Robin E Harmsen
Floris van Braam Houckgeest
Johannes P van der Sluijs
Jean Charles Preiser
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II