Early glycaemic variability increases 28-day mortality and prolongs intensive care unit stay in critically ill patients with pneumonia

Abstract

Objective This study aimed to evaluate the effect of early glycaemic variability (GV) on 28-day mortality in critically ill patients with pneumonia. Patients and methods This single-centre retrospective study included patients admitted to the intensive care unit (ICU) due to pneumonia between 2018 and 2019. A total of 282 patients (mean age, 68.6 years) with blood sugar test (BST) results measured more than three times within 48 h after hospitalization and haemoglobin A1c (HbA1c) levels recorded within 2 months were enrolled. Coefficient of variation (CV) was calculated using the BST values. The effects of GV on 28-day mortality and prolonged ICU stay (>14 days) were also assessed. Results The mean age was 60.6 years (male to female ratio, 2.5:1). The 28-day mortality rate was 31.6% ( n = 89) and was not different according to the presence of diabetes (DM vs. non-DM) or HbA1c levels (≥7.5 vs. <7.5%; both p > .05). However, the mortality rate was significantly higher in patients with high GV (CV ≥ 36%) than in those with low GV (CV < 36%; 37.5 vs. 25.4%, p = .028). The risk of mortality in patients with high GV was prominent in the subgroups with DM or low HbA1c levels. Among the surviving patients ( n = 193), 44 remained in the ICU for more than 14 days. Compared to low GV, high GV was associated with a higher rate of prolonged ICU stay, although not statistically significant (27.8 vs . 18.5%, p = .171). After adjusting for the severity of illness and treatment strategy, CV was an independent risk factor for 28-day mortality (hazard ratio [HR], 1.01, p = .04) and prolonged ICU stay (odds ratio, 1.02; p = .04). Conclusions High GV within 48 h of ICU admission was associated with an increased 28-day mortality risk and prolonged ICU stay. Early phase GV should be carefully managed in critically ill patients with pneumonia. KEY MESSAGES The presence of diabetes or HbA1c alone is insufficient to predict 28-day mortality and prolonged ICU stay in critically ill patients with pneumonia. High glycaemic variability (GV) within 48 h of ICU admission increases 28-day mortality and prolongs ICU stay, which is consistent after adjusting for severity of illness and treatment strategy. Patients with high GV, especially those with DM or low HbA1c levels (<7.5%) should be more carefully treated to reduce mortality.

Olive Oil and Vegetable Extract in Modified Hospital Enteral Formula Improves Glycemic Variability in Critically-Ill Diabetic Ketoacidosis Obese Patient: A Case Report

“…The improvement of glycemic variability in this patient was also accompanied by other positive impact, including a decrease in insulin dose and a shorter length of stay in the ICU. Study by Kim et al 15 showed that high GV within 48 hours of ICU admission was associated with prolonged ICU stay (>14 days). This patient was successfully transferred from ICU to the medical ward on the 12th day of hospitalization despite high GV (61%) within 24 hours of ICU admission.…”

“…12 Studies have shown that high GV in critically-ill patients is associated with an increased risk of mortality and prolonged ICU stay. [13][14][15] Administration of diabetes specific formula (DSF) has been shown to be associated with significant reductions in postprandial blood glucose, mean blood glucose levels, HbA1C, and mean insulin dose thus contributing to good glycemic variability. 16,17 In the absence of DSF, the use of modified hospital-based enteral formula can be considered.…”

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

“…Elevated acute GV has been recognized as a potential predictor of poor survival in patients with sepsis [ 25 ]. High GV has also been associated with adverse outcomes in critically ill patients [ 26 , 27 ], including being an independent risk factor for in-hospital mortality in intensive care unit patients, partly due to an increased risk of ventricular arrhythmias [ 28 ]. Elevated acute GV could be an indicator of unfavorable functional results and death in patients with intracerebral hemorrhage [ 29 ].These results underscore the significance of monitoring and managing GV in various clinical settings to improve patient outcomes and reduce the risk of adverse outcomes.…”

Not so fast: Paradoxically increased variability in the glucose tolerance test due to food withdrawal in continuous glucose-monitored mice

“…Indeed, glycemic variability a measure that carries physiologic and clinical significance. For example, high glycemic variability predicts mortality in populations of critically ill patients and is thought to be the driver of vascular complications of diabetes [ [30] , [31] , [32] , [33] ]. It has also been suggested that measures of glycemic variability may be more reliably diagnostic of impaired glucose tolerance than commonly used clinical measures including the hemoglobin A1c and the oral glucose tolerance test [ 31 , 34 ].…”