Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes
| Autor: | Michael Goldberg, Christian D. Becker, Ralph L. Sabang, Monica F. Nogueira Cordeiro, Corey Scurlock, Ibrahim A. Hassan |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Critical Illness 030204 cardiovascular system & hematology Odds Cohort Studies Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Catecholamines Adrenal Cortex Hormones Risk Factors Internal medicine Diabetes mellitus medicine Diabetes Mellitus Odds Ratio Humans Hypoglycemic Agents Insulin 030212 general & internal medicine Hospital Mortality Glycemic APACHE Retrospective Studies Academic Medical Centers Critically ill business.industry Retrospective cohort study General Medicine Odds ratio Length of Stay Middle Aged medicine.disease Confidence interval Intensive Care Units Logistic Models Treatment Outcome Hyperglycemia Female business Cohort study |
| Zdroj: | The American journal of medicine. 133(10) |
| ISSN: | 1555-7162 |
| Popis: | We aimed to robustly categorize glycemic control in our medical intensive care unit (ICU) as either acceptable or suboptimal based on time-weighted daily blood glucose averages of180 mg/dL or180 mg/dL; identify clinical risk factors for suboptimal control; and compare clinical outcomes between the 2 glycemic control categories.This was a retrospective cohort study in an academic tertiary and quaternary medical ICU.Out of total of 974 unit stays over a 2-year period, 920 had complete data sets available for analysis. Of unit stays 63% (575) were classified as having acceptable glycemic control and the remaining 37% were classified (345) as having suboptimal glycemic control. Adjusting for covariables, the odds of suboptimal glycemic control were highest for patients with diabetes mellitus (odds ratio [OR] 5.08, 95% confidence interval [CI] 3.72-6.93), corticosteroid use during the ICU stay (OR 4.50, 95% CI 3.21-6.32), and catecholamine infusions (OR 1.42, 95% CI 1.04-1.93). Adjusting for acuity, acceptable glycemic control was associated with decreased odds of hospital mortality but not ICU mortality (OR 0.65, 95% CI 0.48-0.88 and OR 0.81, 95% CI 0.55-1.17, respectively). Suboptimal glycemic control was associated with increased odds of longer-than-predicted ICU and hospital stays (OR 1.76, 95% CI 1.30-2.38 and OR 1.50, 95% CI 1.12-2.01, respectively).In our high-acuity medically critically ill patient population, achieving time-weighted average daily blood glucose levels180 mg/dL reliably while in the ICU significantly decreased the odds of subsequent hospital mortality. Suboptimal glycemic control during the ICU stay, on the other hand, significantly increased the odds of longer-than-predicted ICU and hospital stay. |
| Databáze: | OpenAIRE |
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