Hypoglycemia at admission is associated with in-hospital mortality in Ugandan patients with severe sepsis.
Crit Care Med. 2011 Jun 9;
Authors: Ssekitoleko R, Jacob ST, Banura P, Pinkerton R, Meya DB, Reynolds SJ, Kenya-Mugisha N, Mayanja-Kizza H, Muhindo R, Bhagani S, Scheld WM, Moore CC
OBJECTIVE:: Dysglycemia during sepsis is associated with poor outcomes in resource-rich settings. In resource-limited settings, hypoglycemia is often diagnosed clinically without the benefit of laboratory support. We studied the utility of point-of-care glucose monitoring to predict mortality in severely septic patients in Uganda. DESIGN:: Prospective observational study. SETTING:: One national and two regional referral hospitals in Uganda. PATIENTS:: We enrolled 532 patients with sepsis at three hospitals in Uganda. The analysis included 418 patients from the three sites with in-hospital mortality data, a documented admission blood glucose concentration, and evidence of organ dysfunction at admission (systolic blood pressure ?100 mm Hg, lactate >4 mmol/L, platelet number <100,000/?L, or altered mental status). INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We evaluated the association between admission point-of-care blood glucose concentration and in-hospital mortality. We also assessed the accuracy of altered mental status as a predictor of hypoglycemia. Euglycemia occurred in 33.5% (140 of 418) of patients, whereas 16.3% (68 of 418) of patients were hypoglycemic and 50.2% (210 of 418) were hyperglycemic. Univariate Cox regression analyses comparing in-hospital mortality among hypoglycemic (35.3% [24 of 68], hazard ratio 2.0, 95% confidence interval 1.2-3.6, p = .013) and hyperglycemic (29.5% [62 of 210], hazard ratio 1.5, 95% confidence interval 0.96-2.4, p = .08) patients to euglycemic (19.3% [27 of 140]) patients showed statistically significantly higher rates of in-hospital mortality for patients with hypoglycemia. Hypoglycemia (adjusted hazard ratio 1.9, 95% confidence interval 1.1-3.3, p = .03) remained significantly and independently associated with in-hospital mortality in the multivariate model. The sensitivity and specificity of altered mental status for hypoglycemia were 25% and 86%, respectively. CONCLUSION:: Hypoglycemia is an independent risk factor for in-hospital mortality in patients with severe sepsis and cannot be adequately assessed by clinical examination. Correction of hypoglycemia may improve outcomes of critically ill patients in resource-limited settings.
PMID: 21666451 [PubMed - as supplied by publisher]