November 2005
Dr Chan Yan Fat, Alfred
Pamela Youde Nethersole Eastern Hospital
Abstract
Objective: to evaluate (1) glycemic control in an intensive care setting; and (2) analyze its correlation with adverse clinical outcomes
Methods: Retrospective analysis of patients’ record was performed. Following data was collected: demographics, comorbidities, diabetes history, admission diagnosis, serum glucose level, hemoglucostix readings and frequency of monitoring. Inadequate monitoring was defined as hemoglucostix being checked for less than 4 times per day. Parameters of glycemic control: mean hemoglucostix levels, distribution of readings by percentage in different defined ranges. Patients with adequate monitoring and stay in intensive care unit ³ 72 hours entered into outcomes analysis. Clinical outcomes: deaths, new cardiac events, acquired bacteremia and prolonged courses of antibiotics ³10 days for nosocomial infection.
Results: Eighty-eight patients were eligible for study. Hemoglucostix were checked at an average of 4.6 ± 2.2 times per day. Mean serum glucose before admission was 9.9 ± 5.5mmol/l, and 28.3% had values above 8mmol/l. Mean hemogluostix reading achieved was 7.2 ± 4.9mmol/l, and almost half of readings fell outside 4-8mmol/l. Fifteen had inadequate monitoring, and 15 were discharged < 72 hours. Of 58 patients in final analysis, multi-variate logistic regression showed glucose ³ 7.5mmol/l independently predicted acquired bacteremia (OR 4.00, 1.80-9.17, p<0.01), new cardiac events (3.30, 1.48-5.00, p<0.01) and hospital deaths (2.32, 1.96-4.58, p<0.01) after adjusting for age, sex, diabetes state and comorbidities.
Conclusion: This study showed that glycemic control in current intensive care setting still leaves room for much improvement. Hyperglycemia ³ 7.5mmol/l is a strong predictor of adverse clinical outcomes. Future studies are needed to evaluate the effect of tighter glycemic control on outcomes.
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