Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients.
Crit Care. 2015 Apr 8;19(1):153
Authors: Kalfon P, Le Manach Y, Ichai C, Bréchot N, Cinotti R, Dequin PF, Riu-Poulenc B, Montravers P, Annane D, Dupont H, Sorine M, Riou B, CGAO-REA Study Group
INTRODUCTION: Using a randomized controlled trial comparing tight glucose control with a computerized decision-support systems and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity.
METHODS: We looked for moderate (2.2-3.3 mmol/l) and severe (<2.2 mmol/l) hypoglycemia, multiple hypoglycemic events (n ≥ 3), and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary end-point was 90-day mortality. We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm, caliper width of 10(-5) digit with no replacement).
RESULTS: A total of 2,601 patients were analyzed and divided into three groups: no hypoglycemia (n = 1,474), moderate hypoglycemia (n = 874, 34%), and severe hypoglycemia (n = 253, 10%). Patients with moderate or severe hypoglycemia had a poorer prognosis as shown by a higher mortality rate (36% and 54% respectively, vs. 28%) and decreased number of treatment-free days. In the multivariable analysis, severe (OR 1.50, 95% CI 1.36-1.56, P = 0.043) and multiple hypoglycemic events (OR 1.76, 95% CI 1.31-3.37, P < 0.001) were significantly associated with mortality whereas blood glucose CV was not. Using multivariable matching, patients with severe (53 vs. 35%, P < 0.001), moderate (33 vs. 27%, P = 0.029), and multiple hypoglycemic events (46 vs. 32%, P < 0.001), had a higher 90-day mortality.
CONCLUSION: In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.
TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT01002482 Registered 26 Octobrer 2009.
PMID: 25888011 [PubMed - as supplied by publisher]