ORIGINAL ARTICLEHypoglycemia and Outcome in Critically Ill Patients
Section snippets
PATIENTS AND METHODS
Data collection and data analysis were approved by the local institutional ethics committees, which waived the need for informed consent. The Austin Hospital Ethics Committee approved this investigation.
We conducted the study in 2 teaching hospital ICUs in Melbourne and Sydney, Australia. All patients admitted from January 1, 2000, to October 14, 2004, were included in the study. Both ICUs admitted adult medical and surgical patients, including cardiac and neurosurgical cases. We studied all
RESULTS
We studied 4946 ICU patients with 125,036 glucose measurements (mean measurements/day, 5.7) and identified 1109 patients (22.4%) with at least 1 episode of hypoglycemia. Their unadjusted hospital mortality was greater than that of the 3837 nonhypoglycemic patients (controls) (36.6% vs 19.7%; unadjusted OR, 2.35; 95% CI, 2.03-2.72; P<.001). A multivariate model for mortality was found to be highly discriminatory (area under the curve [AUC], 0.80) and well calibrated (Hosmer-Lemeshow statistic, P
DISCUSSION
We sought to understand the epidemiology, severity, duration, recovery, and outcome associations of hypoglycemiain critically ill patients. We found that 22.4% of patients experienced at least one blood glucose value less than 81 mg/dL and 2.1% sustained at least one value less than 40 mg/dL. Hypoglycemia had an increased adjusted risk of hospital death, and its severity (whether spontaneous or insulin-associated) was independently associated with higher mortality. In contrast, among patients
CONCLUSION
We found an independent association between even mild or moderate hypoglycemia and mortality. This association persisted after adjustment for insulin therapy. In hypoglycemic patients, severity of hypoglycemia was independently associated with mortality, but severity of hyperglycemia was not. The association between hypoglycemia and mortality remained even after patients who had hypoglycemia in the 24 hours before death were excluded. One-third of episodes of hypoglycemia were
Acknowledgments
We acknowledge the assistance of the ICU nurses who performed all measurements.
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2022, Journal of Intensive MedicineCitation Excerpt :Low blood glucose has various causes and is called as hypoglycemia when glucose levels in blood are <2.8 mmol/L (<3.9 mmol/L in diabetic patients) along with particular signs and symptoms.[20] The incidence of hypoglycemia is 18–65% in critically ill patients[14] and the mortality is approximately 35.4–50.2% in patients with severe hypoglycemia.[7,21] Hypoglycemia is independently associated with increased mortality in critically ill patients and the risk increases with time and number of hypoglycemic episodes.[7]
This study was supported by a grant from the Austin Hospital Intensive Care Trust Fund.