NYMC Faculty Publications
Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes
DOI
10.1016/j.amjmed.2020.03.012
Journal Title
The American Journal of Medicine
First Page
568
Last Page
568
Document Type
Article
Publication Date
10-2020
Department
Medicine
Second Department
Anesthesiology
Keywords
APACHE, Academic Medical Centers, Adrenal Cortex Hormones, Catecholamines, Cohort Studies, Critical Illness, Diabetes Mellitus, Female, Hospital Mortality, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Intensive Care Units, Length of Stay, Logistic Models, Male, Middle Aged, Odds Ratio, Retrospective Studies, Risk Factors, Tertiary Care Centers, Treatment Outcome
Disciplines
Medicine and Health Sciences
Abstract
BACKGROUND: We aimed to robustly categorize glycemic control in our medical intensive care unit (ICU) as either acceptable or suboptimal based on time-weighted daily blood glucose averages of/dL or >180 mg/dL; identify clinical risk factors for suboptimal control; and compare clinical outcomes between the 2 glycemic control categories.
METHODS: This was a retrospective cohort study in an academic tertiary and quaternary medical ICU.
RESULTS: Out of total of 974 unit stays over a 2-year period, 920 had complete data sets available for analysis. Of unit stays 63% (575) were classified as having acceptable glycemic control and the remaining 37% were classified (345) as having suboptimal glycemic control. Adjusting for covariables, the odds of suboptimal glycemic control were highest for patients with diabetes mellitus (odds ratio [OR] 5.08, 95% confidence interval [CI] 3.72-6.93), corticosteroid use during the ICU stay (OR 4.50, 95% CI 3.21-6.32), and catecholamine infusions (OR 1.42, 95% CI 1.04-1.93). Adjusting for acuity, acceptable glycemic control was associated with decreased odds of hospital mortality but not ICU mortality (OR 0.65, 95% CI 0.48-0.88 and OR 0.81, 95% CI 0.55-1.17, respectively). Suboptimal glycemic control was associated with increased odds of longer-than-predicted ICU and hospital stays (OR 1.76, 95% CI 1.30-2.38 and OR 1.50, 95% CI 1.12-2.01, respectively).
CONCLUSIONS: In our high-acuity medically critically ill patient population, achieving time-weighted average daily blood glucose levels/dL reliably while in the ICU significantly decreased the odds of subsequent hospital mortality. Suboptimal glycemic control during the ICU stay, on the other hand, significantly increased the odds of longer-than-predicted ICU and hospital stay.
Recommended Citation
Becker, C. D., Sabang, R. L., Nogueira Cordeiro, M. F., Hassan, I. F., Goldberg, M. D., & Scurlock, C. S. (2020). Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes. The American Journal of Medicine, 133 (10), 568-568. https://doi.org/10.1016/j.amjmed.2020.03.012
