Mild hypoglycemia is independently associated with increased mortality in the critically ill

被引：140

作者：

Krinsley, James S. ^{[1
]}

Schultz, Marcus J. ^{[2
,3
]}

Spronk, Peter E. ^{[2
,4
]}

Harmsen, Robin E. ^{[2
]}

Houckgeest, Floris van Braam ^{[5
]}

van der Sluijs, Johannes P. ^{[6
]}

Melot, Christian ^{[7
]}

Preiser, Jean Charles ^{[8
]}

机构：

[1] Columbia Univ, Stamford Hosp, Coll Phys & Surg, Div Crit Care, Stamford, CT 06902 USA

[2] Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Lab Expt Intens Care & Anesthesiol, NL-1105 AZ Amsterdam, Netherlands

[4] Gelre Hosp, Dept Intens Care, NL-7334 DZ Apeldoorn, Netherlands

[5] Tergooi Hosp, Dept Intens Care, NL-1261 AN Blaricum, Netherlands

[6] Med Ctr Haaglanden, Dept Intens Care Med, NL-2512 VA The Hague, Den Haag, Netherlands

[7] Erasme Univ Hosp, Dept Emergency Med, B-1070 Brussels, Belgium

[8] Erasme Univ Hosp, Dept Intens Care, B-1070 Brussels, Belgium

来源：

CRITICAL CARE | 2011年 / 15卷 / 04期

关键词：

INTENSIVE INSULIN THERAPY; GLYCEMIC CONTROL; HETEROGENEOUS POPULATION; GLUCOSE MEASUREMENT; BLOOD; VARIABILITY; MANAGEMENT; HYPERGLYCEMIA; ADMISSION;

D O I：

10.1186/cc10322

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: Severe hypoglycemia (blood glucose concentration (BG) < 40 mg/dL) is independently associated with an increased risk of mortality in critically ill patients. The association of milder hypoglycemia (BG < 70 mg/dL) with mortality is less clear. Methods: Prospectively collected data from two observational cohorts in the USA and in The Netherlands, and from the prospective GLUCONTROL trial were analyzed. Hospital mortality was the primary endpoint. Results: We analyzed data from 6,240 patients: 3,263 admitted to Stamford Hospital (ST), 2,063 admitted to three institutions in The Netherlands (NL) and 914 who participated in the GLUCONTROL trial (GL). The percentage of patients with hypoglycemia varied from 18% to 65% among the different cohorts. Patients with hypoglycemia experienced higher mortality than did those without hypoglycemia even after stratification by severity of illness, diagnostic category, diabetic status, mean BG during intensive care unit (ICU) admission and coefficient of variation (CV) as a reflection of glycemic variability. The relative risk (RR, 95% confidence interval) of mortality associated with minimum BG < 40, 40 to 54 and 55 to 69 mg/dL compared to patients with minimum BG 80 to 109 mg/dL was 3.55 (3.02 to 4.17), 2.70 (2.31 to 3.14) and 2.18 (1.87 to 2.53), respectively (all P < 0.0001). The RR of mortality associated with any hypoglycemia < 70 mg/dL was 3.28 (2.78 to 3.87) (P < 0.0001), 1.30 (1.12 to 1.50) (P = 0.0005) and 2.11 (1.62 to 2.74) (P < 0.0001) for the ST, NL and GL cohorts, respectively. Multivariate regression analysis demonstrated that minimum BG < 70 mg/dL, 40 to 69 mg/dL and < 40 mg/dL were independently associated with increased risk of mortality for the entire cohort of 6,240 patients (odds ratio (OR) (95% confidence interval (CI)) 1.78 (1.39 to 2.27) P < 0.0001), 1.29 (1.11 to 1.51) P = 0.0011 and 1.87 (1.46 to 2.40) P < 0.0001) respectively. Conclusions: Mild hypoglycemia was associated with a significantly increased risk of mortality in an international cohort of critically ill patients. Efforts to reduce the occurrence of hypoglycemia in critically ill patients may reduce mortality

引用

页数：10

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