Blood glucose concentration and outcome of critical illness: the impact of diabetes.
OBJECTIVE
To study the impact of diabetes mellitus on the relationship between glycemia and mortality in critically ill patients.


METHODS
Retrospective observational study.


METHODS
Intensive care units of two university hospitals.


METHODS
Cohort of 4946 critically ill patients including 728 patients with diabetes mellitus.


METHODS
None.


RESULTS
We assessed and compared the relationship between glycemia during intensive care unit stay and mortality in diabetic and nondiabetic patients. There were 125,036 blood glucose measurements (5.7 measurements/day on average). Intensive care unit mortality increased significantly with increasing mean blood glucose concentration in nondiabetes mellitus patients but not in diabetes mellitus patients. Nondiabetes mellitus patients with a time-weighted glucose concentration (Glu(Tw)) between 8.0 and 10.0 mmol/L were found to be 1.74 times more likely to die in intensive care unit as diabetes mellitus patients in the same range (odds ratio = 1.74 [1.13-2.68] p = 0.01). They were also more than three times more likely to die in the intensive care unit compared with diabetes mellitus patients when the Glut(w )was between 10.0 and 11.1 mmol/L (odds ratio = 3.34 [1.35-8.23] p = 0.009). Using multivariate logistic regression analysis, hyperglycemia was strongly and independently associated with outcome in nondiabetic patients (p < 0.001) but showed no significant association with outcome in diabetic patients.


CONCLUSIONS
Unlike nondiabetic patients, diabetic patients show no clear association between hyperglycemia during intensive care unit stay and mortality and markedly lower odds ratios of death at all levels of hyperglycemia. These findings suggest that, in critically patients with diabetes mellitus, hyperglycemia may have different biological and/or clinical implications.
Egi
Moritoki
M
Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.
Bellomo
Rinaldo
R
Stachowski
Edward
E
French
Craig J
CJ
Hart
Graeme K
GK
Hegarty
Colin
C
Bailey
Michael
M
D018806:APACHE; D001786:Blood Glucose; D016638:Critical Illness / Q000145:classification / Q000401:mortality*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D038321:Glycemic Index; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies; D016019:Survival Analysis
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin