Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization

Abstract

BackgroundThere was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This retrospective cohort study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the optimal MBG range.MethodsSepsis patients were enrolled from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). MBG and glycemic coefficient of variation (GluCV) were, respectively, calculated to represent the overall glycemic status and GV during ICU stay. The associations between MBG, GluCV, and ICU mortality of the septic patients were assessed by using multivariate logistic regression in different subgroups and the severity of sepsis. Restricted cubic splines evaluated the optimal MBG target.ResultsA total of 7,104 adult sepsis patients were included. The multivariate logistic regression results showed that increased MBG and GluCV were significantly correlated with ICU mortality. The adjusted odds ratios were 1.14 (95% CI 1.09–1.20) and 1.05 (95% CI 1.00–1.12). However, there was no association between hyperglycemia and ICU mortality among diabetes, liver disease, immunosuppression, and hypoglycemia patients. And the impact of high GluCV on ICU mortality was not observed in those with diabetes, immunosuppression, liver disease, and non-septic shock. The ICU mortality risk of severe hyperglycemia (≧200 mg/dl) and high GluCV (>31.429%), respectively, elevated 2.30, 3.15, 3.06, and 2.37, 2.79, 3.14-folds in mild (SOFA ≦ 3), middle (SOFA 3–7), and severe group (SOFA ≧ 7). The MBG level was associated with the lowest risk of ICU mortality and hypoglycemia between 120 and 140 mg/dl in the subgroup without diabetes. For the diabetic subset, the incidence of hypoglycemia was significantly reduced when the MBG was 140–190 mg/dl, but a glycemic control target effectively reducing ICU mortality was not observed.ConclusionMBG and GluCV during the ICU stay were associated with all-cause ICU mortality in sepsis patients; however, their harms are not apparent in some particular subgroups. The impact of hyperglycemia and high GV on death increased with the severity of sepsis. The risk of ICU mortality and hypoglycemia in those with no pre-existing diabetes was lower when maintaining the MBG in the range of 120–140 mg/dl.

Identification of new co-diagnostic genes for sepsis and metabolic syndrome using single-cell data analysis and machine learning algorithms

“…The metabolic changes that cause hyperglycemia include muscle glycolysis and lipolysis, followed by hepatic glycogenesis and glycolysis ( Hirasawa et al, 2009 ; Ferreira et al, 2022 ). Among patients with Sepsis, variability in blood glucose levels is associated with higher mortality rates ( Ali et al, 2008 ; Lu et al, 2022 ). In addition to insulin resistance, metabolic dysfunction is also correlated with the MetS ( Marette et al, 2014 ).…”

Application of Machine Learning for Clinical Subphenotype Identification in Sepsis

“…A mild elevation of glucose is acceptable because it allows the host to survive during severe stress. However, an excessively high level of glucose may cause immunosuppression and oxidative stress, which were associated with worse outcomes [ 25 , 26 ]. Serum creatinine is the most widely used measure of renal function in clinical practice.…”

Red Blood Cell Distribution Width is Associated with Short-term Mortality in Critically Ill Patients with Type 2 Diabetes Mellitus

“…Several studies have reported an association between increased RDW and increased glycosylated hemoglobin (HbA1c) levels, which re ects the magnitude of glycemic variability in patients with diabetes. Furthermore, these studies reported that hyperglycemia shortens the lifespan of red blood cells, leading to a highly variable red blood cell volume or RDW, which is associated with increased mortality [22][23][24][25]. In addition, RDW is associated with the development of diabetes-related complications.…”