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J Crit Care. 2018 Jun;45:170-177. doi: 10.1016/j.jcrc.2018.03.012. Epub 2018 Mar 3.

Early glycemia and mortality in critically ill septic patients: Interaction with insulin-treated diabetes.

Author information

1
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
2
Australian and New Zealand Intensive Care Research Centre (ANZIC RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia.
3
Australian and New Zealand Intensive Care Research Centre (ANZIC RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; The Department of Intensive Care, Alfred Health, Commercial Road, Prahran, Melbourne, VIC, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Levers Terrace, Carlton, VIC, Australia.
4
Section of Anesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
5
Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Medicine, The University of Melbourne, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia. Electronic address: Rinaldo.bellomo@austin.org.au.

Abstract

PURPOSE:

To investigate the relationship between dysglycemia and hospital mortality in patients with and without a preadmission diagnosis of insulin treated diabetes mellitus (ITDM).

MATERIALS AND METHODS:

An observational multicentre cohort study using the ANZICS-APD database on adult patients admitted to ICU with sepsis between January 1st 2006 and December 31st 2015. Four domains of dysglycemia were investigated (highest, mean and lowest blood glucose levels and glycemic variability: the absolute difference between the highest and lowest level). The association between a preadmission diagnosis of ITDM and hospital mortality in each domain was analysed.

RESULTS:

We studied 90,644 septic patients including 5127 patients with ITDM. We found that septic ICU patients with ITDM have lower adjusted hospital mortality with higher peak blood glucose levels in the first 24 h while non-ITDM patients have increased mortality (interaction p 0.012). We found that this significant difference was replicated when assessing glycemic variability (interaction p 0.048).

CONCLUSIONS:

Septic patients with a pre-existing diagnosis of ITDM show a different relationship between hospital mortality and highest glucose levels and glycemic variability in the first 24 h than those without ITDM. These findings provide a rationale for an ITDM-specific approach to the management of dysglycemia.

KEYWORDS:

Blood glucose; Diabetes; Dysglycemia; Glycemic variability; Hyperglycemia; Hypoglycemia; Sepsis

PMID:
29544173
DOI:
10.1016/j.jcrc.2018.03.012

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