Early blood glucose control and mortality in critically ill patients in Australia.
OBJECTIVE
To measure temporal trends in blood glucose (BG) control and describe their association with hospital mortality in a cohort of critically ill patients from Australia.


METHODS
Interrogation of prospectively collected data from the Australia New Zealand Intensive Care Society Adult Patient Database.


METHODS
Twenty-four intensive care units (ICU) across Australia.


METHODS
A cohort of 66,184 adult ICU admissions for >or=24 hours from January 1, 2000, to December 31, 2005.


METHODS
None.


RESULTS
Highest and lowest BG values within 24 hours of ICU admission, standard demographic, clinical, and physiologic data, and hospital mortality. Medical, mechanically ventilated surgical, cardiac surgical, and septic subgroups were evaluated. Average BG was evaluated as a continuous variable and by quartiles (low [<5.6 mmol/L], near normal [5.6-8.69 mmol/L], high [8.69-11.79 mmol/L], and highest [>11.79 mmol/L]). There were 132,368 BG values, with a mean (95% confidence intervals) value 8.69 mmol/L (8.66-8.73). There was no trend in BG for the entire cohort (p = 0.66) over the study period; yet, BG increased after 2002 (0.17 mmol/L, p < 0.0001). The mechanically ventilated surgical and cardiac surgical subgroups had decreasing trends in BG (p < 0.001), whereas the septic subgroup had an increasing BG trend (p < 0.001). BG in the low, high, and highest quartiles, compared with the near-normal quartile, were consistently associated with higher hospital mortality in crude (odds ratio 1.31, 1.58, and 2.00) and multivariable analysis (odds ratio 1.29, 1.07, and 1.10), respectively. This association was similarly shown for the mechanically ventilated surgical and cardiac surgical subgroups.


CONCLUSIONS
In a large cohort of ICU patients from Australia, there was no significant change in early glycemic control from 2000 to 2005. There were differences in selected subgroups. Average BG decreased in surgical subgroups, whereas it increased in septic patients. Both high and early low BG values were independently associated with hospital mortality.
Bagshaw
Sean M
SM
Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada. bagshaw@ualberta.ca
Egi
Moritoki
M
George
Carol
C
Bellomo
Rinaldo
R
D000368:Aged; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016017:Odds Ratio; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology; D013903:Thoracic Surgery
D001786:Blood Glucose