Siegelaar SE, Hermanides J, Oudemans-van Straaten HM, van der Voort PH, Bosman RJ, Zandstra DF, Devries JH.; Crit Care. 2010 Dec 10;14(6):R224.
INTRODUCTION: Lowering of hyperglycaemia in the intensive care unit (ICU) is widely practised. We investigated in which way glucose regulation, defined as mean glucose concentration during admission, is associated with ICU mortality in a medical and a surgical cohort.
METHODS: Retrospective database cohort study including patients admitted between January 2004 and December 2007 in a 20-bed medical/surgical ICU in a teaching hospital. Hyperglycaemia was treated using a computerized algorithm targeting for glucose levels of 4.0-7.0 mmol/l. 5828 patients were eligible for analyses, of whom 1339 patients had a medical and 4489 had a surgical admission diagnosis.
RESULTS: The cohorts were subdivided in quintiles of increasing mean glucose. We examined the relation between these mean glucose strata and mortality. In both cohorts we observed the highest mortality in the lowest and highest strata. Logistic regression analysis adjusted for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, admission duration and occurrence of severe hypoglycemia showed that in the medical cohort mean glucose levels <6.7 mmol/l and >8.4 mmol/l and in the surgical cohort mean glucose levels < 7.0 mmol/l and >9.4 mmol/l were associated with significantly increased ICU mortality (OR 2.4-3.0 and 4.9-6.2 respectively). Limitations of the study were its retrospective design and possible incomplete correction for severity of disease.
CONCLUSIONS: Mean overall glucose during ICU admission is related to mortality by a U-shaped curve in medical and surgical patients. In this cohort of patients a ‘safe range’ of mean glucose regulation might be defined approximately between 7.0 and 9.0 mmol/l.
Weblink here