Malglycemia in the critical care setting. Part III : Temporal patterns, relative potencies, and hospital mortality
Copyright © 2023. Published by Elsevier Inc..
INTRODUCTION: The relationship between critical care mortality and combined impact of malglycemia remains undefined.
METHODS: We assessed the risk-adjusted relationship (n = 4790) between hospital mortality with malglycemia, defined as hypergycemia (hours Glycemic Ratio ≥ 1.1, where GR is quotient of mean ICU blood glucose (BG) and estimated average BG), absolute hypoglycemia (hours BG < 70 mg/dL) and relative hypoglycemia (excursions GR < 0.7 in those with HbA1c ≥ 8%).
RESULTS: Each malglycemia was independently associated with mortality - hyperglycemia (OR 1.0020/h, 95%CI 1.0009-1.0031, p = 0.0004), absolute hypoglycemia (OR 1.0616/h, 95%CI 1.0190-1.1061, p = 0.0043), and relative hypoglycemia (OR 1.2813/excursion, 95%CI 1.0704-1.5338, p = 0.0069). Absolute (7.4%) and relative hypoglycemia (6.7%) exposure dominated the first 24 h, decreasing thereafter. While hyperglycemia had lower risk association with mortality, it was persistently present across the length-of-stay (68-76% incidence daily), making it the dominant form of malglycemia. Relative contributions in the first five days from hyperglycemia, absolute hypoglycemia and relative hypoglycemia were 60%, 21% and 19% respectively.
CONCLUSIONS: Absolute and relative hypoglycemia occurred largely in the first 24 h. Relative to all hypoglycemia, the associated mortality from the seemingly less potent but consistently more prevalent hyperglycemia steadily accumulated with increasing length-of-stay. This has important implications for interpretation of study results.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:81 |
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| Enthalten in: |
Journal of critical care - 81(2024) vom: 01. Apr., Seite 154537 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Roberts, Gregory W [VerfasserIn] |
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| Links: |
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| Themen: |
Blood Glucose |
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| Anmerkungen: |
Date Completed 03.04.2024 Date Revised 03.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2024.154537 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Roberts, Gregory W |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Malglycemia in the critical care setting. Part III |b Temporal patterns, relative potencies, and hospital mortality |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 03.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023. Published by Elsevier Inc. | ||
| 520 | |a INTRODUCTION: The relationship between critical care mortality and combined impact of malglycemia remains undefined | ||
| 520 | |a METHODS: We assessed the risk-adjusted relationship (n = 4790) between hospital mortality with malglycemia, defined as hypergycemia (hours Glycemic Ratio ≥ 1.1, where GR is quotient of mean ICU blood glucose (BG) and estimated average BG), absolute hypoglycemia (hours BG < 70 mg/dL) and relative hypoglycemia (excursions GR < 0.7 in those with HbA1c ≥ 8%) | ||
| 520 | |a RESULTS: Each malglycemia was independently associated with mortality - hyperglycemia (OR 1.0020/h, 95%CI 1.0009-1.0031, p = 0.0004), absolute hypoglycemia (OR 1.0616/h, 95%CI 1.0190-1.1061, p = 0.0043), and relative hypoglycemia (OR 1.2813/excursion, 95%CI 1.0704-1.5338, p = 0.0069). Absolute (7.4%) and relative hypoglycemia (6.7%) exposure dominated the first 24 h, decreasing thereafter. While hyperglycemia had lower risk association with mortality, it was persistently present across the length-of-stay (68-76% incidence daily), making it the dominant form of malglycemia. Relative contributions in the first five days from hyperglycemia, absolute hypoglycemia and relative hypoglycemia were 60%, 21% and 19% respectively | ||
| 520 | |a CONCLUSIONS: Absolute and relative hypoglycemia occurred largely in the first 24 h. Relative to all hypoglycemia, the associated mortality from the seemingly less potent but consistently more prevalent hyperglycemia steadily accumulated with increasing length-of-stay. This has important implications for interpretation of study results | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Blood glucose | |
| 650 | 4 | |a Critical care | |
| 650 | 4 | |a Glycemic ratio | |
| 650 | 4 | |a Hypoglycemia | |
| 650 | 4 | |a Malglycemia | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Stress-induced hyperglycemia | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 700 | 1 | |a Krinsley, James S |e verfasserin |4 aut | |
| 700 | 1 | |a Preiser, Jean-Charles |e verfasserin |4 aut | |
| 700 | 1 | |a Quinn, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Rule, Peter R |e verfasserin |4 aut | |
| 700 | 1 | |a Brownlee, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Umpierrez, Guillermo E |e verfasserin |4 aut | |
| 700 | 1 | |a Hirsch, Irl B |e verfasserin |4 aut | |
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