TY - JOUR
T1 - Degree of hyperglycemia independently associates with hospital mortality and length of stay in critically ill, nondiabetic patients
T2 - Results from the ANZICS CORE binational registry
AU - Mamtani, Manju
AU - Kulkarni, Hemant
AU - Bihari, Shailesh
AU - Prakash, Shivesh
AU - Chavan, Shaila
AU - Huckson, Sue
AU - Pilcher, David
PY - 2020/2
Y1 - 2020/2
N2 - Purpose: Hyperglycemia (HG) in critically ill patients influences clinical outcomes and hospitalization costs. We aimed to describe association of HG with hospital mortality and length of stay in large scale, real-world scenario. Materials: From The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) we included 739,152 intensive care unit (ICU) patients admitted during 2007–2016. Hyperglycemia was quatified using midpoint blood glucose level (MBGL). Association with outcomes (hospital mortality and length of stay (LOS)) was tested using multivariable, mixed effects, 2-level hierarchical regression. Results: Degree of HG (defined using MBGL as a continuous variable) was significantly associated with hospital mortality and longer hospital stay in a dose-dependent fashion. The fourth, third and second MBGL (compared to the first) quartiles were associated with hospital mortality (odds ratio 1.34, 1.05 and 0.97, respectively) and longer hospital stay (1.56, 1.38 and 0.93 days, respectively). These associations were stronger associations in trauma (especially head injury), neurological disease and coma patients. Significant variation across ICUs was observed for all associations. Conclusions: In this largest study of nondiabetic ICU patients, HG was associated with both study outcomes. This association was differential across ICUs and diagnostic categories.
AB - Purpose: Hyperglycemia (HG) in critically ill patients influences clinical outcomes and hospitalization costs. We aimed to describe association of HG with hospital mortality and length of stay in large scale, real-world scenario. Materials: From The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) we included 739,152 intensive care unit (ICU) patients admitted during 2007–2016. Hyperglycemia was quatified using midpoint blood glucose level (MBGL). Association with outcomes (hospital mortality and length of stay (LOS)) was tested using multivariable, mixed effects, 2-level hierarchical regression. Results: Degree of HG (defined using MBGL as a continuous variable) was significantly associated with hospital mortality and longer hospital stay in a dose-dependent fashion. The fourth, third and second MBGL (compared to the first) quartiles were associated with hospital mortality (odds ratio 1.34, 1.05 and 0.97, respectively) and longer hospital stay (1.56, 1.38 and 0.93 days, respectively). These associations were stronger associations in trauma (especially head injury), neurological disease and coma patients. Significant variation across ICUs was observed for all associations. Conclusions: In this largest study of nondiabetic ICU patients, HG was associated with both study outcomes. This association was differential across ICUs and diagnostic categories.
KW - Hospital mortality
KW - Hypoglycemia
KW - Intensive care
KW - Length of stay
KW - Stress-induced hyperglycemia
UR - http://www.scopus.com/inward/record.url?scp=85074714430&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2019.11.003
DO - 10.1016/j.jcrc.2019.11.003
M3 - Article
C2 - 31731174
AN - SCOPUS:85074714430
SN - 0883-9441
VL - 55
SP - 149
EP - 156
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -