Blood glucose control among critically ill patients with brain injury.
OBJECTIVE
To evaluate the incidence of hypoglycemia, hyperglycemia and blood glucose (BG) variability in brain-injured patients and their association with clinical outcomes.


METHODS
Retrospective cohort study of brain-injured patients admitted to an 11-bed neurosciences intensive care unit (ICU) from January 1 to December 31, 2003.


RESULTS
We included 606 patients. Mean age was 52.3 years, 60.6% were male, 11.9% had diabetes mellitus, and 64% were post-operative. Seventy-five (12.4%) received intensive insulin therapy (IIT) for a median (IQR) 72 (24-154) hours. Hypoglycemia and hyperglycemia occurred in 4.6% (96.4% receiving IIT) and 9.6% (77.6% receiving IIT). Median number of episodes per patient was 3 (75% with > or = 2) and 4 (81% with > or = 2) for hypoglycemia and hyperglycemia. Variable glycemic control occurred in 3.8% (100% receiving IIT) with median number of 13 episodes per patient. In-hospital mortality was 16.7%, median (IQR) ICU and hospital lengths of stay were 2 (1-5) and 8 (3-19) days. Hypoglycemia, hyperglycemia and BG variability showed non-significant but consistent associations with hospital mortality and prolonged lengths of ICU and hospital stay. The rate of recurrence of episodes showed stronger and significant associations with outcome, in particular for BG variability and hyperglycemia.


CONCLUSIONS
Hypoglycemia, hyperglycemia and BG variability are relatively common in brain-injured patients and are associated with IIT. An increased frequency of episodes, in particular for BG variability and hyperglycemia, was associated with greater risk of both hospital death and prolonged duration of stay.
Jacka
Michael J
MJ
Department of Anaesthesiology and Pain Medicine, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Torok-Both
Clinton J
CJ
Bagshaw
Sean M
SM
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001930:Brain Injuries / Q000097:blood* / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D007003:Hypoglycemia / Q000097:blood / Q000150:complications*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D001786:Blood Glucose