Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis

Wen Cheng Chao, Chien Hua Tseng, Chieh Liang Wu, Sou Jen Shih, Chi Yuan Yi, Ming Cheng Chan

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Background: High glycemic variability (GV) is common in critically ill patients; however, the prevalence and mortality association with early GV in patients with sepsis remains unclear. Methods: This retrospective cohort study was conducted in a medical intensive care unit (ICU) in central Taiwan. Patients in the ICU with sepsis between January 2014 and December 2015 were included for analysis. All of these patients received protocol-based management, including blood sugar monitoring every 2 h for the first 24 h of ICU admission. Mean amplitude of glycemic excursions (MAGE) and coefficient of variation (CoV) were used to assess GV. Results: A total of 452 patients (mean age 71.4 ± 14.7 years; 76.7% men) were enrolled for analysis. They were divided into high GV (43.4%, 196/452) and low GV (56.6%, 256/512) groups using MAGE 65 mg/dL as the cut-off point. Patients with high GV tended to have higher HbA1c (6.7 ± 1.8% vs. 5.9 ± 0.9%, p < 0.01) and were more likely to have diabetes mellitus (DM) (50.0% vs. 23.4%, p < 0.01) compared with those in the low GV group. Kaplan–Meier analysis showed that a high GV was associated with increased 30-day mortality (log-rank test, p = 0.018). The association remained strong in the non-DM (log-rank test, p = 0.035), but not in the DM (log-rank test, p = 0.254) group. Multivariate Cox proportional hazard regression analysis identified that high APACHE II score (adjusted hazard ratio (aHR) 1.045, 95% confidence interval (CI) 1.013–1.078), high serum lactate level at 0 h (aHR 1.009, 95% CI 1.003–1.014), having chronic airway disease (aHR 0.478, 95% CI 0.302–0.756), high mean day 1 glucose (aHR 1.008, 95% CI 1.000–1.016), and high MAGE (aHR 1.607, 95% CI 1.008–2.563) were independently associated with increased 30-day mortality. The association with 30-day mortality remained consistent when using CoV to assess GV. Conclusions: We found that approximately 40% of the septic patients had a high early GV, defined as MAGE > 65 mg/dL. Higher GV within 24 h of ICU admission was independently associated with increased 30-day mortality. These findings highlight the need to monitor GV in septic patients early during an ICU admission.

Original languageEnglish
Article number17
JournalAnnals of Intensive Care
Volume10
Issue number1
DOIs
Publication statusPublished - Dec 1 2020

Keywords

  • Glycemic control
  • Glycemic variability
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis'. Together they form a unique fingerprint.

Cite this