Average Daily Risk Range as a Measure of Glycemic Risk is Associated with Mortality in the Intensive Care Unit: A Retrospective Study in a Burn Intensive Care Unit

Abstract

Background: Although tight glycemic control has been associated with improved outcomes in the intensive care unit (ICU), glycemic variability may be the influential factor in mortality. The main goal of the study was to relate blood glucose (BG) variability of burn ICU patients to outcomes using a sensitive measure of glycemic variability, the average daily risk range (ADRR). Method: Data from patients admitted to a burn ICU were used. Patients were matched by total body surface area (TBSA) and injury severity score (ISS) to test whether increased BG variability measured by ADRR was associated with higher mortality risk and whether we could identify ADRR-based classifications associated with the degree of risk. Results: Four ADRR classifications were identified: Low risk, medium-low, medium-high, and high. Mortality progressively increased from 25% in the low-risk group to over 60% in the high-risk group ( p < .001). In a post hoc analysis, age also contributed to outcome. Younger (age < 43 years) survivors and nonsurvivors matched by TBSA and ISS had no significant difference in age, mean BG or standard deviation of BG; however, nonsurvivors had higher ADRR ( p < .01). Conclusions: Independent of injury severity, glycemic variability measured by the ADRR was significantly associated with mortality in the ICU. When age was considered, ADRR was the only measure of glycemia significantly associated with mortality in younger patients with burns.

Clinical Impact of Sample Interference on Intensive Insulin Therapy in Severely Burned Patients

“…For example, CV, IQR, and SD, all global determinants of variability, are unable to evaluate day-to-day or hour-to-hour burn patient glycemic variability. 26 In contrast, MAGE, MODD, and CONGA are most sensitive to hourly and daily variations as suggested by their mathematical derivation and our study data. Therefore, MAGE, MODD, and CONGA measurements may be compatible with burn patient pathophysiology.…”

Population-specific models of glycemic control in intensive care: Towards a simulation-based methodology for protocol optimization

“…Following [50], [51], [52], there is a natural asymmetry of disutility associated with BG excursions below and above euglycemia. While hyperglycemia is associated with infection and slow wound healing, insulin overdose resulting in hypoglycemia presents an acute short term risk that must be avoided.…”

High Glucose Variability in Hospitalized Patients with Type 1 Diabetes Mellitus

“…6 The above measurements have shown to be a reliable representation of patients' glycemic control as illustrated in several studies. 7 Concurrent with the development of CGM and new measures of GV, randomized controlled trials (RCT) to achieve tight glucose control in hospitalized patients have been conducted and reported. 8,9 These studies have focused on all hospitalized patients and have included subjects from normal glucose tolerance to diabetes mellitus.…”