TY - JOUR
T1 - The Glycemic Ratio Is Strongly and Independently Associated With Mortality in the Critically Ill
AU - Roberts, Greg
AU - Krinsley, James S.
AU - Preiser, Jean-Charles
AU - Quinn, Stephen
AU - Rule, Peter R.
AU - Brownlee, Michael
AU - Schwartz, Michael
AU - Umpierrez, Guillermo E.
AU - Hirsch, Irl B.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Interventional studies investigating blood glucose (BG) management in intensive care units (ICU) have been inconclusive. New insights are needed. We assessed the ability of a new metric, the Glycemic Ratio (GR), to determine the relationship of ICU glucose control relative to preadmission glycemia and mortality. Methods: Retrospective cohort investigation (n = 4790) in an adult medical-surgical ICU included patients with minimum four BGs, hemoglobin (Hgb), and hemoglobin A1c (HbA1c). The GR is the quotient of mean ICU BGs (mBG) and estimated preadmission BG, derived from HbA1c. Results: Mortality displayed a J-shaped curve with GR (nadir GR 0.9), independent of background glycemia, consistent for HbA1c <6.5% vs >6.5%, and Hgb >10 g/dL vs <10 g/dL and medical versus surgical. An optimal range of GR 0.80 to 0.99 was associated with decreased mortality compared with GR above and below this range. The mBG displayed a linear relationship with mortality at lower HbA1c but diminished for HbA1c >6.5%, and dependent on preadmission glycemia. In adjusted analysis, GR remained associated with mortality (odds ratio = 2.61, 95% confidence interval = 1.48-4.62, P =.0012), but mBG did not (1.004, 1.000-1.009,.059). A single value on admission was not independently associated with mortality. Conclusions: The GR provided new insight into malglycemia that was not apparent using mBG, or an admission value. Mortality was associated with acute change from preadmission glycemia (GR). Further assessment of the impact of GR deviations from the nadir in mortality at GR 0.80 to 0.99, as both relative hypo- and hyperglycemia, and as duration of exposure and intensity, may further define the multifaceted nature of malglycemia.
AB - Background: Interventional studies investigating blood glucose (BG) management in intensive care units (ICU) have been inconclusive. New insights are needed. We assessed the ability of a new metric, the Glycemic Ratio (GR), to determine the relationship of ICU glucose control relative to preadmission glycemia and mortality. Methods: Retrospective cohort investigation (n = 4790) in an adult medical-surgical ICU included patients with minimum four BGs, hemoglobin (Hgb), and hemoglobin A1c (HbA1c). The GR is the quotient of mean ICU BGs (mBG) and estimated preadmission BG, derived from HbA1c. Results: Mortality displayed a J-shaped curve with GR (nadir GR 0.9), independent of background glycemia, consistent for HbA1c <6.5% vs >6.5%, and Hgb >10 g/dL vs <10 g/dL and medical versus surgical. An optimal range of GR 0.80 to 0.99 was associated with decreased mortality compared with GR above and below this range. The mBG displayed a linear relationship with mortality at lower HbA1c but diminished for HbA1c >6.5%, and dependent on preadmission glycemia. In adjusted analysis, GR remained associated with mortality (odds ratio = 2.61, 95% confidence interval = 1.48-4.62, P =.0012), but mBG did not (1.004, 1.000-1.009,.059). A single value on admission was not independently associated with mortality. Conclusions: The GR provided new insight into malglycemia that was not apparent using mBG, or an admission value. Mortality was associated with acute change from preadmission glycemia (GR). Further assessment of the impact of GR deviations from the nadir in mortality at GR 0.80 to 0.99, as both relative hypo- and hyperglycemia, and as duration of exposure and intensity, may further define the multifaceted nature of malglycemia.
KW - Critical illness
KW - diabetes
KW - glycemic ratio
KW - hyperglycemia
KW - hypoglycemia
KW - malglycemia
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85138285992&partnerID=8YFLogxK
U2 - 10.1177/19322968221124114
DO - 10.1177/19322968221124114
M3 - Article
C2 - 36112804
AN - SCOPUS:85138285992
SN - 1932-2968
VL - 18
SP - 335
EP - 344
JO - Journal of Diabetes Science and Technology
JF - Journal of Diabetes Science and Technology
IS - 2
ER -