Hypoglycemia was associated with increased mortality in ICU patients regardless of glucose control strategy.
Ann Intern Med. 2013 Jan 15;158(2):JC3
Authors: Rice TW
Abstract
QUESTION Is moderate or severe hypoglycemia associated with increased risk for mortality in critically ill adults? METHODS DESIGN Post hoc analysis of a randomized controlled trial (Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation [NICE-SUGAR] trial). ClinicalTrials.gov NCT00220987. ALLOCATION {Concealed}*.† BLINDING {Unblinded}*†. FOLLOW-UP PERIOD 90 days. SETTING 42 hospital intensive care units (ICUs). PATIENTS 6104 adults (mean age 60 y, 63% men) {who were admitted to an ICU in the past 24 hours}* and expected to be in the ICU for ? 3 days. Exclusion criteria included increased risk for hypoglycemia and past hypoglycemia without full neurologic recovery. INTERVENTION Intensive glucose control targeting blood glucose levels of 4.5 to 6.0 mmol/L (81 to 108 mg/dL) {n = 3054}*, or conventional glucose control targeting blood glucose levels ? 10.0 mmol/L (? 180 mg/dL) {n = 3050}*. OUTCOMES Moderate hypoglycemia (blood glucose level 2.3 to 3.9 mmol/L [41 to 70 mg/dL]), severe hypoglycemia (blood glucose level ? 2.2 mmol/L ? 40 mg/dL]), and 90-day mortality. PATIENT FOLLOW-UP 99%. MAIN RESULTS Intensive glucose control increased both moderate (74% vs 16%, P < 0.001) and severe (6.9% vs 0.5%, P < 0.001) hypoglycemia more than conventional control. Moderate and severe hypoglycemia were each associated with increased risk for 90-day mortality compared with no hypoglycemia (Table); results were consistent in both the intensive and conventional glucose control groups (P = 0.22 for interaction). CONCLUSIONS In critically ill adults, intensive glucose control increased moderate and severe hypoglycemia more than conventional control. Moderate and severe hypoglycemia were each associated with increased risk for mortality compared with no hypoglycemia, regardless of intensity of glucose control treatment.Association between hypoglycemia and mortality in critically ill adults‡ComparisonsEvent ratesHazard ratio (95% CI)§Moderate|| vs no hypoglycemia29% vs 24%1.41 (1.21 to 1.62)Severe¶ vs no hypoglycemia35% vs 24%2.10 (1.59 to 2.77)‡CI defined in Glossary.§Stratified by treatment (intensive vs conventional glucose control) and adjusted for baseline (age; sex; body mass index; intensive care unit admission status; Acute Physiology and Chronic Health Evaluation II score; blood glucose level; use of renal replacement or corticosteroid therapy; and presence of sepsis, trauma, diabetes, or organ failure) and postrandomization, time-dependent (organ failure, new infection, mechanical ventilation, renal replacement therapy, systemic corticosteroid therapy, parenteral nutrition, and red blood cell transfusion) characteristics.||Blood glucose level 2.3 to 3.9 mmol/L (41 to 70 mg/dL).¶Blood glucose level ? 2.2 mmol/L (? 40 mg/dL).
PMID: 23318337 [PubMed - in process]