Relative Hypoglycemia in Diabetic Patients With Critical Illness

Kwan, Timothy N; Hessels, Lara; Marhoon, Nada; Robbins, Rebecca J.; Mårtensson, Johan; Ekinci, Elif I; Bellomo, Rinaldo

doi:10.1097/ccm.0000000000004213

Cited by 34 publications

(24 citation statements)

References 36 publications

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“…10 Hypoglycemia was defined as blood glucose level below 4.0 mmol/L after admission. 11 study outcomes For non-critical patients at admission, we used a composite outcome to analyze the association between glucoserelevant indexes and the risk of progression to critical cases/death. The composite outcome was reached when any of the following outcomes occurred, which included admission to ICU, mechanical ventilation, hemodynamic compromise or death.…”

Section: Data Collection and Definitionmentioning

confidence: 99%

Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

Huang

Zhu

et al. 2020

BMJ Open Diab Res Care

144

129

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IntroductionWith intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.Research design and methodsWe collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.ResultsElevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.ConclusionsElevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

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Section: Data Collection and Definitionmentioning

confidence: 99%

Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

Huang

Zhu

et al. 2020

BMJ Open Diab Res Care

144

129

View full text Add to dashboard Cite

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“…A retrospective observational study found a stronger association between absolute hypoglycemia and mortality in patients with higher A1C than in those with lower A1C levels 5 . Additionally, relative hypoglycemia, defined as < 70% of ADAG but not below 70 mg/dL, was reported to be a mortality risk factor 16 . On the other hand, because the range considered as relative normoglycemia under our definition widens with higher A1C, there is concern about glycemic variability which is associated with mortality 3 , 19 , 20 .…”

Section: Discussionmentioning

confidence: 99%

“…The TIR of relative normoglycemia was defined as the time spent between 70 and 140% of the ADAG during the first 72 h (or ICU stay, whichever was shorter) divided by 72 h (or ICU stay, whichever was shorter). The lower threshold was adopted from a previous study on relative hypoglycemia 16 based on an average blood glucose level of 100 mg/dL in healthy people and a hypoglycemic threshold of 70 mg/dL. In contrast, 140 mg/dL is widely accepted as the threshold for hyperglycemia.…”

Section: Methodsmentioning

confidence: 99%

Association between time in range of relative normoglycemia and in-hospital mortality in critically ill patients: a single-center retrospective study

Okazaki

Inoue

Taira

et al. 2022

Sci Rep

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The aim of this single-center retrospective study was to investigate the association between the time in range (TIR) of relative normoglycemia (RN) and in-hospital mortality. We defined RN as measured blood glucose in the range of 70–140% of A1C-derived average glucose and absolute normoglycemia (AN) as 70–140 mg/dL. We conducted multivariate logistic regression analyses to examine the association between TIR of RN > 80% or TIR of AN > 80% up to 72 h after ICU admission and in-hospital mortality (Model 1 and Model 2, respectively). The discrimination of the models was assessed using the area under the receiver operating characteristic curve (AUROC). Among 328 patients, 35 died in hospital (11%). Model 1 showed that TIR of RN > 80% was associated with reduced in-hospital mortality (adjusted OR 0.16; 95% CI 0.06–0.43; P < 0. 001); however, Model 2 showed that the TIR of AN > 80% was not. The AUROC of Model 1 was significantly higher than that of Model 2 (0.84 [95% CI 0.77–0.90] vs. 0.79 [0.70–0.87], P = 0.008).Our findings provide a foundation for further studies exploring individualized glycemic management in ICUs.

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“…In addition, our data did show a relatively higher risk of CRBSIs in patients using the cutoff value for the glucose level of > 10 mmol/L rather than 7.7 mmol/L [ 13 ], but the rate of CRBSIs was relatively lower in patients with diabetes mellitus. A recent cohort study reported that relative hypoglycemia is common in ICU patients with diabetes [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study

et al. 2021

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Introduction Catheter management strategies for suspected catheter-related bloodstream infection (CRBSI) remain a major challenge in intensive care units (ICUs). The objective of this study was to determine the incidence, risk factors, and mortality attributable to CRBSIs in those patients. Methods A population-based surveillance on suspected CRBSI was conducted from 2009 to 2018 in a tertiary care hospital in China. We used the results of catheter tip culture to identify patients with suspected CRBSIs. Demographics, systemic inflammatory response syndrome (SIRS) criteria, interventions, and microorganism culture results were analysed and compared between patients with and without confirmed CRBSIs. Univariate and multivariate analyses identified the risk factors for CRBSIs, and attributable mortality was evaluated with a time-varying Cox proportional hazard model. Results In total, 686 patients with 795 episodes of suspected CRBSIs were included; 19.2% (153/795) episodes were confirmed as CRBSIs, and 17.4% (119/686) patients died within 30 days. The multifactor model shows that CRBSIs were associated with fever, hypotension, acute respiratory distress syndrome, hyperglycaemia and the use of continuous renal replacement therapy. The AUC was 77.0% (95% CI 73.3%–80.7%). The population attributable mortality fraction of CRBSI in patients was 18.2%, and mortality rate did not differ significantly between patients with and without CRBSIs (95% CI 0.464–1.279, P = 0.312). Conclusions This initial model based on the SIRS criteria is relatively better at identifying patients with CRBSI but only in domains of the sensitivity. There were no significant differences in attributable mortality due to CRBSI and other causes in patients with suspected CRBSI, which prompt catheter removal and re-insertion of new catheter may not benefit patients with suspected CRBSIs. Trial Registration China Clinical Trials Registration number; ChiCTR1900022175. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00429-3.

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Relative Hypoglycemia in Diabetic Patients With Critical Illness

Cited by 34 publications

References 36 publications

Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

Association between time in range of relative normoglycemia and in-hospital mortality in critically ill patients: a single-center retrospective study

Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study

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