Glycemic lability index and mortality in critically ill patients-A multicenter cohort study.
critical care
diabetes
glycemic variability
hyperglycemia
hypoglycemia
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
19
03
2021
received:
30
01
2021
accepted:
13
04
2021
pubmed:
9
5
2021
medline:
16
10
2021
entrez:
8
5
2021
Statut:
ppublish
Résumé
Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship. In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA-BG (above vs. below cohort median) with hospital mortality. Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L] In adult patients admitted to an ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.
Sections du résumé
BACKGROUND
BACKGROUND
Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship.
METHODS
METHODS
In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA-BG (above vs. below cohort median) with hospital mortality.
RESULTS
RESULTS
Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L]
CONCLUSION
CONCLUSIONS
In adult patients admitted to an ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.
Substances chimiques
Blood Glucose
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1267-1275Subventions
Organisme : regional agreement on medical and clinical research (ALF) between Stockholm County Council and Karolinska Institutet
Informations de copyright
© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
Whitcomb BW, Pradhan EK, Pittas AG, et al. Impact of admission hyperglycemia on hospital mortality in various intensive care unit populations. Crit Care Med. 2005;33:2772-2777.
Falciglia M, Freyberg RW, Almenoff PL, et al. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009;37:3001-3009. https://doi.org/10.1097/CCM.0b013e3181b083f7
Krinsley JS, Egi M, Kiss A, et al. Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study. Crit Care. 2013;17:R37. https://doi.org/10.1186/cc12547
Nolan JP, Soar J, Cariou A, et al. European resuscitation council and European society of intensive care medicine guidelines for post-resuscitation care 2015: section 5 of the European resuscitation council guidelines for resuscitation 2015. Resuscitation. 2015;95:202-222. https://doi.org/10.1016/j.resuscitation.2015.07.018
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304-377. https://doi.org/10.1007/s00134-017-4683-6
Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. New Engl J Med. 2009;360:1283-1297. https://doi.org/10.1056/NEJMoa0810625
Al-Dorzi HM, Tamim HM, Arabi YM. Glycaemic fluctuation predicts mortality in critically ill patients. Anaesth Intensive Care. 2010;38:695-702. https://doi.org/10.1177/0310057X1003800413
Ceriello A, Esposito K, Piconi L, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008;57:1349-1354. https://doi.org/10.2337/db08-0063
Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295:1681-1687. https://doi.org/10.1001/jama.295.14.1681
Egi M, Bellomo R, Stachowski E, et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105:244-252.
Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med. 2008;36:3008-3013. https://doi.org/10.1097/CCM.0b013e31818b38d2
Ali NA, OʼBrien JM, Dungan K, et al. Glucose variability and mortality in patients with sepsis. Crit Care Med. 2008;36:2316-2321. https://doi.org/10.1097/CCM.0b013e3181810378
Plummer MP, Finnis ME, Horsfall M, et al. Prior exposure to hyperglycaemia attenuates the relationship between glycaemic variability during critical illness and mortality. Crit Care Resusc. 2016;18:189-197.
Donati A, Damiani E, Domizi R, et al. Glycaemic variability, infections and mortality in a medical-surgical intensive care unit. Crit Care Resusc. 2014;16:13-23.
Balintescu A, Palmgren I, Lipcsey M, et al. Prevalence and impact of chronic dysglycemia in intensive care unit patients-a retrospective cohort study. Acta Anaesthesiol Scand. 2021;65:82-91. https://doi.org/10.1111/aas.13695
Luethi N, Cioccari L, Biesenbach P, et al. Liberal glucose control in ICU patients with diabetes: a before-and-after study. Crit Care Med. 2018;46:935-942. https://doi.org/10.1097/CCM.0000000000003087
Moreno RP, Metnitz PGH, Almeida E, et al. SAPS 3-from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31:1345-1355. https://doi.org/10.1007/s00134-005-2763-5
Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619-1636. https://doi.org/10.1378/chest.100.6.1619
Ryan EA, Shandro T, Green K, et al. Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes. 2004;53:955-962. https://doi.org/10.2337/diabetes.53.4.955
Finfer S, Liu B, Chittock DR, et al. Hypoglycemia and risk of death in critically ill patients. New Eng J Medicine. 2012;367:1108-1118. https://doi.org/10.1056/NEJMoa1204942
Rodbard D. The challenges of measuring glycemic variability. J Diabetes Sci Technol. 2012;6:712-715.
Hermanides J, Vriesendorp TM, Bosman RJ, et al. Glucose variability is associated with intensive care unit mortality. Crit Care Med. 2010;38:838-842. https://doi.org/10.1097/CCM.0b013e3181cc4be9
Balintescu A, Mårtensson J. Hemoglobin A1c and permissive hyperglycemia in patients in the intensive care unit with diabetes. Crit Care Clin. 2019;35:289-300. https://doi.org/10.1016/j.ccc.2018.11.010
Krinsley JS, Schultz MJ, Spronk PE, et al. Mild hypoglycemia is independently associated with increased mortality in the critically ill. Crit Care. 2011;15:R173. https://doi.org/10.1186/cc10322
Ancona P, Eastwood G, Lucchetta L, et al. The performance of flash glucose monitoring in critically ill patients with diabetes. Criti Care Resusc: J Aus Acad Criti Care Med. 2017;19:167-174.