title: Differences in complexity of glycemic profile in survivors and nonsurvivors in an intensive care unit: a pilot study.
abstract: OBJECTIVE
  To investigate glycemic dynamics and its relation with mortality in critically ill patients. We searched for differences in complexity of the glycemic profile between survivors and nonsurvivors in patients admitted to a multidisciplinary intensive care unit.
  
  
  METHODS
  Prospective, observational study, convenience sample.
  
  
  METHODS
  Multidisciplinary intensive care unit of a teaching hospital in Madrid, Spain.
  
  
  METHODS
  A convenience sample of 42 patients, aged 29 to 86 yrs, admitted to an intensive care unit with an Acute Physiology and Chronic Health Evaluation II score of >or=14 and with an anticipated intensive care unit stay of >72 hrs.
  
  
  METHODS
  A continuous glucose monitoring system was used to measure subcutaneous interstitial fluid glucose levels every 5 mins for 48 hrs during the first days of intensive care unit stay. A 24-hr period (n = 288 measurements) was used as time series for complexity analysis of the glycemic profile.
  
  
  METHODS
  Complexity of the glycemic profile was evaluated by means of detrended fluctuation analysis. Other conventional measurements of variability (range, sd, and Mean Amplitude of Glycemic Excursions) were also calculated.
  
  
  RESULTS
  Ten patients died during their intensive care unit stay. Glycemic profile was significantly more complex (lower detrended fluctuation analysis) in survivors (mean detrended fluctuation analysis, 1.49; 95% confidence interval, 1.44-1.53) than in nonsurvivors (1.60; 95% confidence interval, 1.52-1.68). This difference persisted after accounting for the presence of diabetes. In a logistic regression model, the odds ratio for death was 2.18 for every 0.1 change in detrended fluctuation analysis.Age, gender, Simplified Acute Physiologic Score 3 or Acute Physiologic and Chronic Health Evaluation II scores failed to explain differences in survivorship. Conventional variability measurements did not differ between survivors and nonsurvivors.
  
  
  CONCLUSIONS
  Complexity of the glycemic profile of critically ill patients varies significantly between survivors and nonsurvivors. Loss of complexity in glycemia time series, evaluated by detrended fluctuation analysis, is associated with higher mortality.
authors.affiliation: Servicio de Medicina Interna, Hospital de Mostoles, Madrid, Spain.
authors.forename: Krista
authors.initials: K
authors.lastname: Lundelin
authors.forename: Luis
authors.initials: L
authors.lastname: Vigil
authors.forename: Susana
authors.initials: S
authors.lastname: Bua
authors.forename: Ivan
authors.initials: I
authors.lastname: Gomez-Mestre
authors.forename: Teresa
authors.initials: T
authors.lastname: Honrubia
authors.forename: Manuel
authors.initials: M
authors.lastname: Varela
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000401:mortality*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose