Background
Methods
Study design
Patients
Exposures and outcome
Standard ICU care
Data collection
Statistical analysis
Results
Participants
Baseline and admission-related characteristics
Variable | All patients | Admitted > 72 h | ||||||
---|---|---|---|---|---|---|---|---|
ICU survivors (n = 3695) | ICU non-survivors (n = 271) | p valuea | All (n = 3966) | ICU survivors (n = 1354) | ICU non-survivors (n = 196) | p valuea | All > 72 h (n = 1550) | |
Age (years) | 68.8 ± 13.7 | 70.3 ± 12.7 | 0.05 | 68.9 ± 13.6 | 69.0 ± 13.2 | 71.4 ± 12.0 | 0.019 | 69.3 ± 13.1 |
Gender (male) | 2377 (64.3) | 161 (59.4) | 0.11 | 2538 (64.0) | 861 (63.6) | 122 (62.2) | 0.775 | 983 (63.4) |
Body mass index (kg/m2) | 27.1 ± 6.2 | 26.9 ± 5.4 | 0.59 | 26.9 ± 5.4 | 27.2 ± 6.0 | 27.0 ± 6.1 | 0.640 | 27.1 ± 6.0 |
History of diabetesb | 771 (20.8) | 66 (24.4) | 0.19 | 837 (21.1) | 304 (22.5) | 44 (22.4) | 1.000 | 348 (22.5) |
Insulin dependent | 315 (8.5) | 35 (12.9) | 0.02 | 350 (8.8) | 139 (10.3) | 22 (11.2) | 0.775 | 161 (10.4) |
Oral anti-diabetes medication | 547 (14.8) | 37 (13.7) | 0.66 | 584 (14.7) | 203 (15.0) | 24 (12.2) | 0.363 | 227 (14.6) |
History of liver cirrhosis | 57 (1.5) | 8 (3.0) | 0.08 | 65 (1.6) | 21 (1.6) | 3 (1.5) | 1.000 | 24 (1.5) |
Type of admissionc | < 0.001 | < 0.001 | ||||||
Medical | 1680 | 211 | 1891 (47.7) | 814 (60.1) | 144 (73.5) | 958 (61.8) | ||
Elective/scheduled surgery | 1690 (45.7) | 27 (10) | 1717 (43.3) | 385 (28.4) | 24 (12.2) | 409 (26.4) | ||
Urgent/emergency surgery | 325 (8.8) | 33 (12.2) | 358 (9.0) | 155 (11.4) | 28 (14.3) | 183 (11.8) | ||
Cardiothoracic surgery patients | 1715 (46.4) | 33 (1.2) | < 0.001 | 1748 (44.1) | 428 (31.6) | 26 (13.3) | < 0.001 | 454 (29.3) |
Severity of disease scores | ||||||||
APACHE IV PM (%) | 19.6 [2.4 to 28.4] | 60.4 [40.0 to 84.4] | < 0.001 | 22.4 [2.7 to 34.3] | 22.4 [8.0 to 47.9] | 50.7 [29.3 to 80.0] | < 0.001 | 25.2 [9.3 to 53.0] |
SOFA score on admission | 6.4 ± 2.7 | 10.7 ± 3.9 | < 0.001 | 6.7 ± 3.0 | 7.7 ± 3.0 | 9.9 ± 3.6 | < 0.001 | 8.0 ± 3.1 |
Maximum SOFA score | 6.7 ± 2.9 | 12.8 ± 4.0 | < 0.001 | 7.1 ± 3.4 | 8.5 ± 3.1 | 12.4 ± 3.9 | < 0.001 | 9.0 ± 3.4 |
Mechanical ventilation | 3102 (84.0) | 263 (97) | < 0.001 | 3365 (84.8) | 1238 (91.4) | 190 (96.9) | 0.011 | 1428 (92.1) |
Renal replacement therapy | 351 (9.9) | 129 (47.6) | < 0.001 | 480 (12.1) | 295 (21.8) | 92 (46.9) | < 0.001 | 387 (25.0) |
Corticosteroids during admission | 2555 (69) | 248 (91.5) | < 0.001 | 2803 (70.7) | 1199 (88.6) | 183 (93.4) | 0.057 | 1382 (89.2) |
Sodium, average > 145 mmol/L | 160 (4.3) | 34 (12.5) | < 0.001 | 194 (4.9) | 113 (8.3) | 30 (15.3) | 0.003 | 143 (9.2) |
Total parenteral feeding | 90 (2.4) | 21 (7.7) | 0.19 | 111 (2.8) | 70 (5.2) | 21 (10.7) | 0.968 | 91 (5.9) |
Daily intake (kcal) | 678 [339 to 1177] | 1136 [658 to 1495] | < 0.001 | 705 [357 to 1214] | 1300 [974 to 1619] | 1368 [1111 to 1676] | 0.056 | 1312 [985 to 1630] |
Daily intake form enteral feeding (kcal) | 315 [0 to 880] | 830 [467 to 1278] | < 0.001 | 100 [0 to 717] | 790 [49 to 1174] | 864 [475 to 1171] | 0.039 | 803 [60 to 1173] |
Admission day 1 (kcal) | 0 [0 to 288] | 279 [95 to 530] | < 0.001 | 0 [0 to 308] | 171 [0 to 435] | 296 [56 to 543] | 0.001 | 185 [0 to 448] |
Admission day 2 (kcal) | 314 [0 to 937] | 818 [463 to 1199 | < 0.001 | 387 [0 to 959] | 872 [477 to 1199] | 924 [596 to 1248] | 0.320 | 881 [480 to 1199] |
Admission day 3 (kcal) | 480 [0 to 1224] | 1017 [510 to 1439] | < 0.001 | 588 [0 to 1247] | 1199 [802 to 1508] | 1199 [847 to 1507] | 0.964 | 1199 [808 to 1506] |
Length of ICU stay (h) | 51 [38 to 115] | 120 [54 to 244] | < 0.001 | 55.0 [38.0 to 119.0] | 143 [99 to 261] | 190 [121 to 330] | < 0.001 | 148 [102 to 269] |
Mean BG (mmol/L) | 8.3 ± 1.2 | 7.9 ± 1.3 | < 0.001 | 8.3 ± 1.2 | 8.0 ± 1.0 | 8.0 ± 0.9 | 0.606 | 8.0 ± 1.0 |
MAG change (mmol/L/h) | 0.36 [0.22 to 0.57] | 0.43 [0.28 to 0.60] | 0.001 | 0.4 [0.2 to 0.6] | 0.3 [0.2 to 0.5] | 0.4 [0.3 to 0.5] | 0.007 | 0.4 [0.2 to 0.5] |
Time in glycemic ranges | ||||||||
BG percentage < 4.4 mmol/L | 0.0 [0.0 to 0.0] | 0.0 [0.0 to 3.0] | < 0.001 | 0.0 [0.0 to 0.0] | 0.0 [0.0 to 0.6] | 0.0 [0.0 to 2.2] | < 0.001 | 0.0 [0.0 to 1.0] |
BG percentage 4.4–5.9 mmol/L | 5.4 [0.0 to 13.7] | 9.5 [3.6 to 20.0] | < 0.001 | 5.7 [0.0 to 14.3] | 8.7 [4.3 to 14.9] | 8.8 [4.1 to 16.7] | 0.878 | 8.7 [4.3 to 15.0] |
BG percentage 6.0–9.0 mmol/L | 61.1 [45.5 to 75.0] | 58.0 [42.9 to 70.0] | 0.006 | 60.9 [45.5 to 75.0] | 64.1 [51.5 to 75.0] | 62.9 [50.0 to 70.6] | 0.340 | 63.9 [51.3 to 74.5] |
BG percentage 9.1–11.1 mmol/L | 20.8 [10.0 to 31.0] | 17.4 [8.6 to 25.8] | < 0.001 | 20.3 [9.9 to 30.8] | 18.9 [9.1 to 26.9] | 18.8 [11.7 to 25.9] | 0.939 | 18.8 [9.6 to 26.8] |
BG percentage > 11.1 mmol/L | 3.0 [0 to 14.3] | 4.2 [0 to 11.9] | 0.22 | 3.1 [0.0 to 13.7] | 3.7 [0.0 to 10.7] | 4.8 [0.0 to 10.9] | 0.221 | 3.9 [0.0 to 10.7] |
Incidence BG < 2.2 mmol/Le | 15 (0.4) | 6 (2.2) | < 0.001 | 21 (0.5) | 11 (0.8) | 4 (2.0) | 0.211 | 15 (1.0) |
Incidence BG < 4.4 mmol/Le | 535 (14.5) | 120 (44.3) | < 0.001 | 655 (16.5) | 371 (27.4) | 88 (44.9) | < 0.001 | 459 (29.6) |
Intravenous insulin (IU) | ||||||||
Number of patients | 2931 (79.3) | 237 (87.5) | 0.001 | 3168 (79.9) | 1205 (89.0) | 184 (93.9) | 0.049 | 1389 (89.6) |
Total amount during admission | 64 [15 to 187] | 216 [60 to 530] | < 0.001 | 69.0 [17.0 to 205.0] | 215 [80 to 483] | 398 [171 to 834] | < 0.001 | 232 [85 to 514] |
Amount per day | 18.7 [4.8 to 39.3] | 34.4 [12 to 60.1] | < 0.001 | 19.5 [5.2 to 40.7] | 27.3 [11.4 to 53.8] | 39.9 [22.9 to 64.1] | < 0.001 | 29.0 [12.2 to 55.1] |
Amount per kg per dayf | 0.24 [0.06 to 0.48] | 0.43 [0.17 to 0.77] | < 0.001 | 0.3 [0.1 to 0.5] | 0.3 [0.1 to 0.6] | 0.5 [0.3 to 0.8] | < 0.001 | 0.4 [0.2 to 0.7] |
Intravenous glucose (g) | ||||||||
Number of patients | 1674 (45.3) | 233 (86.0) | < 0.001 | 1907 (48.1) | 993 (73.3) | 177 (90.3) | < 0.001 | 1170 (75.5) |
Total amount during admission | 0.0 [0.0 to 7.8] | 27.1 [5.1 to 96.7] | < 0.001 | 0.0 [0.0 to 10.4] | 8.7 [0.0 to 33.9] | 38.4 [11.7 to 103.5] | < 0.001 | 10.2 [0.5 to 40.6] |
Amount per day | 0.0 [0.0 to 1.4] | 3.2 [1.2 to 11.9] | < 0.001 | 0.0 [0.0 to 1.8] | 1.1 [0.0 to 3.3] | 3.5 [1.5 to 9.0] | < 0.001 | 1.3 [0.1 to 3.9] |
Fluid balance (L) | 2.2 [0.46 to 4.3] | 9.3 [4.4 to 17.7] | < 0.001 | 2.4 [0.6 to 4.7] | 2.1 [− 0.5 to 5.4] | 8.6 [4.4 to 18.0] | < 0.001 | 2.7 [− 0.2 to 6.4] |
Main results
Variable | ICU mortality (n = 309) | Hospital mortality (n = 455) | ||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
Age (per 10 years) | 1.14 (1.04, 1.25) | 0.006 | 1.26 (1.16, 1.36) | < 0.001 |
Gender (male as reference) | 1.19 (0.94, 1.51) | 0.148 | 1.15 (0.94, 1.41) | 0.172 |
BMI (per kg/m2) | 1.01 (0.99, 1.03) | 0.438 | 1.00 (0.98, 1.01) | 0.577 |
History of diabetes | 1.19 (0.91, 1.57) | 0.203 | 1.27 (1.01, 1.60) | 0.039 |
History of insulin use | 1.55 (1.09, 2.22) | 0.015 | 1.50 (1.10, 2.04) | 0.010 |
History of liver cirrhosis | 2.46 (1.27, 4.76) | 0.007 | 3.81 (2.25, 6.47) | < 0.001 |
Cardiothoracic surgery patients | 0.22 (0.16, 0.30) | < 0.001 | 0.16 (0.12, 0.21) | < 0.001 |
APACHE IV PM (per %) | 1.04 (1.04, 1.05) | < 0.001 | 1.04 (1.04, 1.05) | < 0.001 |
Maximum SOFA score (per point) | 1.50 (1.45, 1.56) | < 0.001 | 1.41 (1.36, 1.45) | < 0.001 |
Corticosteroids during admission | 3.88 (2.67, 5.63) | < 0.001 | 3.28 (2.46, 4.38) | < 0.001 |
Average sodium > 145 mmol/L | 3.26 (2.25, 4.74) | < 0.001 | 3.53 (2.55, 4.89) | < 0.001 |
Total parenteral feeding | 0.79 (0.47, 1.33) | 0.370 | 0.80 (0.49, 1.30) | 0.359 |
Daily intake (all sources, per 100 kcal) | 1.02 (1.01, 1.03) | < 0.001 | 1.03 (1.02, 1.03) | < 0.001 |
Length of ICU stay (per day) | 1.04 (1.03, 1.05) | < 0.001 | 1.04 (1.03, 1.05) | < 0.001 |
Mean BG (per mmol/L) | 0.80 (0.72, 0.89) | < 0.001 | 0.81 (0.75, 0.88) | < 0.001 |
MAG change (per mmol/L/h) | 1.48 (1.03, 2.11) | 0.034 | 1.32 (0.97, 1.80) | 0.083 |
Percentage BG < 4.4 mmol/L (per %) | 1.07 (1.05, 1.09) | < 0.001 | 1.07 (1.05, 1.09) | < 0.001 |
Percentage BG > 11.1 mmol/L (per %) | 1.00 (0.99, 1.01) | 0.649 | 1.00 (0.99, 1.01) | 0.613 |
Incidence glucose < 2.2 mmol/L | 4.81 (1.85, 12.48) | 0.001 | 3.11 (1.20, 8.07) | 0.019 |
Incidence glucose < 4.4 mmol/L | 3.88 (3.04, 4.97) | < 0.001 | 3.51 (2.83, 4.34) | < 0.001 |
IV insulin per kg per day (per 0.1 IU) | 1.10 (1.07, 1.12) | < 0.001 | 1.10 (1.08, 1.12) | < 0.001 |
IV glucose per day (per g increase) | 1.01 (1.01, 1.02) | < 0.001 | 1.01 (1.01, 1.02) | < 0.001 |
Fluid balance (per L increase) | 1.22 (1.19, 1.24) | < 0.001 | 1.17 (1.15, 1.19) | < 0.001 |
Variable | ICU mortality (n = 309) | Hospital mortality (n = 455) | ||
---|---|---|---|---|
Adjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value | |
Age (per 10 years) | 1.21 (1.07, 1.36) | 0.002 | 1.38 (1.25, 1.52) | < 0.001 |
Cardiothoracic surgery patients | 0.61 (0.39, 0.96) | 0.032 | 0.34 (0.23, 0.49) | < 0.001 |
APACHE IV PM (per %) | 1.02 (1.01, 1.03) | < 0.001 | 1.02 (1.01, 1.03) | < 0.001 |
Maximum SOFA score (per point) | 1.26 (1.19, 1.34) | < 0.001 | 1.18 (1.13, 1.24) | < 0.001 |
Average sodium > 145 mmol/L | 2.09 (1.29, 3.40) | 0.003 | 2.17 (1.44, 3.27) | < 0.001 |
Daily intake (from all sources, per 100 kcal) | 0.92 (0.89, 0.95) | < 0.001 | 0.94 (0.91, 0.97) | < 0.001 |
Mean BG (per mmol/L) | 0.83 (0.70, 0.99) | 0.040 | 0.76 (0.66, 0.88) | < 0.001 |
Percentage BG < 4.4 mmol/L (per %) | 1.02 (1.00, 1.05) | 0.089 | 1.02 (1.00, 1.05) | 0.050 |
IV insulin per kg per day (per 0.1 IU) | 1.09 (1.05, 1.13) | < 0.001 | 1.09 (1.06, 1.13) | < 0.001 |
IV glucose per day (per g increase) | 1.01 (1.00, 1.01) | 0.021 | 1.00 (1.00, 1.01) | 0.094 |
Fluid balance (per L increase) | 1.11 (1.08, 1.13) | < 0.001 | 1.08 (1.06, 1.11) | < 0.001 |
Variable | ICU mortality (n = 196) | Hospital mortality (n = 286) | ||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
Age (per 10 years) | 1.16 (1.02, 1.31) | 0.019 | 1.30 (1.16, 1.45) | < 0.001 |
Gender (male as reference) | 1.06 (0.78, 1.44) | 0.715 | 0.96 (0.73, 1.26) | 0.768 |
BMI (per kg/m2) | 0.99 (0.97, 1.02) | 0.640 | 0.98 (0.96, 1.01) | 0.155 |
History of diabetes | 1.00 (0.70, 1.43) | 0.999 | 1.26 (0.94, 1.70) | 0.127 |
History of insulin use | 1.11 (0.69, 1.78) | 0.681 | 1.18 (0.79, 1.77) | 0.424 |
History of liver cirrhosis | 0.99 (0.29, 3.34) | 0.983 | 2.29 (0.97, 5.39) | 0.059 |
Cardiothoracic surgery patients | 0.47 (0.32, 0.69) | < 0.001 | 0.33 (0.23, 0.47) | < 0.001 |
APACHE IV PM (per %) | 1.03 (1.02, 1.03) | < 0.001 | 1.03 (1.02, 1.03) | < 0.001 |
Maximum SOFA score (per point) | 1.38 (1.31, 1.44) | < 0.001 | 1.29 (1.24, 1.35) | < 0.001 |
Corticosteroids during admission | 1.82 (1.01, 3.27) | 0.046 | 1.73 (1.07, 2.81) | 0.027 |
Average sodium > 145 mmol/L | 1.99 (1.29, 3.06) | 0.002 | 2.10 (1.43, 3.08) | < 0.001 |
Total parenteral feeding | 0.95 (0.53, 1.70) | 0.849 | 0.95 (0.55, 1.63) | 0.851 |
Daily intake (from all sources, per 100 kcal) | 1.01 (0.99, 103) | 0.448 | 1.01 (0.99, 1.03) | 0.209 |
Length of ICU stay (per day) | 1.02 (1.00, 1.03) | 0.009 | 1.02 (1.01, 1.03) | 0.003 |
Mean BG (per mmol/L) | 0.96 (0.83, 1.12) | 0.606 | 0.97 (0.85, 1.11) | 0.675 |
MAG change (per mmol/L/h) | 1.32 (0.74, 2.36) | 0.349 | 1.39 (0.84, 2.29) | 0.198 |
Percentage BG < 4.4 mmol/L (per %) | 1.09 (1.05, 1.13) | < 0.001 | 1.09 (1.05, 1.13) | < 0.001 |
Percentage BG > 11.1 mmol/L (per %) | 1.00 (0.98, 1.01) | 0.782 | 1.00 (0.99, 1.02) | 0.722 |
Incidence BG < 2.2 mmol/L | 2.54 (0.80, 8.07) | 0.113 | 1.64 (0.52, 5.20) | 0.397 |
Incidence BG < 4.4 mmol/L | 2.16 (1.59, 2.93) | < 0.001 | 2.03 (1.56, 2.65) | < 0.001 |
IV insulin per kg per day (per 0.1 IU) | 1.07 (1.04, 1.10) | < 0.001 | 1.07 (1.05, 1.10) | < 0.001 |
IV glucose per day (per g increase) | 1.01 (1.00, 1.01) | < 0.001 | 1.01 (1.00, 1.01) | < 0.001 |
Fluid balance (per L increase) | 1.14 (1.12, 1.17) | < 0.001 | 1.11 (1.09, 1.14) | < 0.001 |
Variable | ICU mortality (n = 196) | Hospital mortality (n = 286) | ||
---|---|---|---|---|
Adjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value | |
Age (per 10 years) | 1.25 (1.07, 1.46) | 0.005 | 1.43 (1.25, 1.64) | < 0.001 |
Cardiothoracic surgery patients | 0.68 (0.39, 1.18) | 0.167 | 0.46 (0.28, 0.73) | 0.001 |
APACHE IV PM (per %) | 1.01 (1.00, 1.02) | 0.010 | 1.01 (1.01, 1.02) | < 0.001 |
Maximum SOFA score (per point) | 1.23 (1.15, 1.31) | < 0.001 | 1.15 (1.08, 1.21) | < 0.001 |
Average sodium > 145 mmol/L | 2.00 (1.18, 3.40) | 0.010 | 1.97 (1.25, 3.12) | 0.004 |
Daily intake (from all sources, per 100 kcal) | 0.91 (0.87, 0.96) | < 0.001 | 0.95 (0.91, 0.99) | 0.007 |
Percentage BG < 4.4 mmol/L (per %) | 1.06 (1.01, 1.12) | 0.025 | 1.07 (1.02, 1.12) | 0.003 |
IV insulin per kg per day (per 0.1 IU) | 1.06 (1.02, 1.09) | 0.002 | 1.06 (1.03, 1.09) | < 0.001 |
IV glucose per day (per g increase) | 1.01 (1.00, 1.01) | 0.083 | 1.00 (1.00, 1.01) | 0.204 |
Fluid balance (per L increase) | 1.10 (1.07, 1.12) | < 0.001 | 1.08 (1.05, 1.10) | < 0.001 |