title: Glucose variability and mortality in patients with sepsis.
abstract: OBJECTIVE
  Treatment and prevention of hyperglycemia has been advocated for subjects with sepsis. Glucose variability, rather than the glucose level, has also been shown to be an important factor associated with in-hospital mortality, in general, critically ill patients. Our objective was to determine the association between glucose variability and hospital mortality in septic patients and the expression of glucose variability that best reflects this risk.
  
  
  METHODS
  Retrospective, single-center cohort study.
  
  
  METHODS
  Academic, tertiary care hospital.
  
  
  METHODS
  Adult subjects hospitalized for >1 day, with a diagnosis of sepsis were included.
  
  
  METHODS
  None.
  
  
  METHODS
  Glucose variability was calculated for all subjects as the average and standard deviation of glucose, the mean amplitude of glycemic excursions, and the glycemic lability index. Hospital mortality was the primary outcome variable. Logistic regression was used to determine the odds of hospital death in relation to measures of glucose variability after adjustment for important covariates.
  
  
  RESULTS
  Of the methods used to measure glucose variability, the glycemic lability index had the best discrimination for mortality (area under the curve = 0.67, p < 0.001). After adjustment for confounders, including the number of organ failures and the occurrence of hypoglycemia, there was a significant interaction between glycemic lability index and average glucose level, and the odds of hospital mortality. Higher glycemic lability index was not independently associated with mortality among subjects with average glucose levels above the median for the cohort. However, subjects with increased glycemic lability index, but lower average glucose values had almost five-fold increased odds of hospital mortality (odds ratio = 4.73, 95% confidence interval = 2.6-8.7) compared with those with lower glycemic lability index.
  
  
  CONCLUSIONS
  Glucose variability is independently associated with hospital mortality in septic patients. Strategies to reduce glucose variability should be studied to determine whether they improve the outcomes of septic patients.
authors.affiliation: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine and Center for Critical Care, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio, USA. naeem.ali@osumc.edu
authors.forename: Naeem A
authors.initials: NA
authors.lastname: Ali
authors.forename: James M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dungan
authors.forename: Gary
authors.initials: G
authors.lastname: Phillips
authors.forename: Clay B
authors.initials: CB
authors.lastname: Marsh
authors.forename: Stanley
authors.initials: S
authors.lastname: Lemeshow
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Connors
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Preiser
mesh_terms: D001786:Blood Glucose; D005260:Female; D038321:Glycemic Index; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000401:mortality / Q000503:physiopathology
chemical_list: D001786:Blood Glucose