TY - JOUR
T1 - Malglycemia in the critical care setting. Part III
T2 - Temporal patterns, relative potencies, and hospital mortality
AU - Roberts, Gregory W.
AU - Krinsley, James S.
AU - Preiser, Jean Charles
AU - Quinn, Stephen
AU - Rule, Peter R.
AU - Brownlee, Michael
AU - Umpierrez, Guillermo E.
AU - Hirsch, Irl B.
PY - 2024/6
Y1 - 2024/6
N2 - Introduction: The relationship between critical care mortality and combined impact of malglycemia remains undefined. Methods: We assessed the risk-adjusted relationship (n = 4790) between hospital mortality with malglycemia, defined as hypergycemia (hours Glycemic Ratio ≥ 1.1, where GR is quotient of mean ICU blood glucose (BG) and estimated average BG), absolute hypoglycemia (hours BG < 70 mg/dL) and relative hypoglycemia (excursions GR < 0.7 in those with HbA1c ≥ 8%). Results: Each malglycemia was independently associated with mortality - hyperglycemia (OR 1.0020/h, 95%CI 1.0009–1.0031, p = 0.0004), absolute hypoglycemia (OR 1.0616/h, 95%CI 1.0190–1.1061, p = 0.0043), and relative hypoglycemia (OR 1.2813/excursion, 95%CI 1.0704–1.5338, p = 0.0069). Absolute (7.4%) and relative hypoglycemia (6.7%) exposure dominated the first 24 h, decreasing thereafter. While hyperglycemia had lower risk association with mortality, it was persistently present across the length-of-stay (68–76% incidence daily), making it the dominant form of malglycemia. Relative contributions in the first five days from hyperglycemia, absolute hypoglycemia and relative hypoglycemia were 60%, 21% and 19% respectively. Conclusions: Absolute and relative hypoglycemia occurred largely in the first 24 h. Relative to all hypoglycemia, the associated mortality from the seemingly less potent but consistently more prevalent hyperglycemia steadily accumulated with increasing length-of-stay. This has important implications for interpretation of study results.
AB - Introduction: The relationship between critical care mortality and combined impact of malglycemia remains undefined. Methods: We assessed the risk-adjusted relationship (n = 4790) between hospital mortality with malglycemia, defined as hypergycemia (hours Glycemic Ratio ≥ 1.1, where GR is quotient of mean ICU blood glucose (BG) and estimated average BG), absolute hypoglycemia (hours BG < 70 mg/dL) and relative hypoglycemia (excursions GR < 0.7 in those with HbA1c ≥ 8%). Results: Each malglycemia was independently associated with mortality - hyperglycemia (OR 1.0020/h, 95%CI 1.0009–1.0031, p = 0.0004), absolute hypoglycemia (OR 1.0616/h, 95%CI 1.0190–1.1061, p = 0.0043), and relative hypoglycemia (OR 1.2813/excursion, 95%CI 1.0704–1.5338, p = 0.0069). Absolute (7.4%) and relative hypoglycemia (6.7%) exposure dominated the first 24 h, decreasing thereafter. While hyperglycemia had lower risk association with mortality, it was persistently present across the length-of-stay (68–76% incidence daily), making it the dominant form of malglycemia. Relative contributions in the first five days from hyperglycemia, absolute hypoglycemia and relative hypoglycemia were 60%, 21% and 19% respectively. Conclusions: Absolute and relative hypoglycemia occurred largely in the first 24 h. Relative to all hypoglycemia, the associated mortality from the seemingly less potent but consistently more prevalent hyperglycemia steadily accumulated with increasing length-of-stay. This has important implications for interpretation of study results.
KW - Blood glucose
KW - Critical care
KW - Glycemic ratio
KW - Hypoglycemia
KW - Malglycemia
KW - Mortality
KW - Stress-induced hyperglycemia
UR - http://www.scopus.com/inward/record.url?scp=85185409593&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2024.154537
DO - 10.1016/j.jcrc.2024.154537
M3 - Article
C2 - 38364665
AN - SCOPUS:85185409593
SN - 0883-9441
VL - 81
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154537
ER -