Accuracy of different methods for blood glucose measurement in critically ill patients.
OBJECTIVE
Although glucometers have not been validated for intensive care units, they are regularly used. The aim of this study was to compare and assess the accuracy and clinical agreement of arterial glucose concentration obtained using colorimetry (Agluc-lab), capillary (Cgluc-strip) and arterial (Agluc-strip) glucose concentration obtained using glucometry and central venous glucose concentration obtained using colorimetry (Vgluc-lab).


METHODS
Cross-sectional study in a university hospital.


METHODS
Forty patients with septic shock and stable individuals without infection were included. The correlations between measurements were assessed both in the full sample and in subgroups using noradrenalin and presenting signs of tissue hypoperfusion.


RESULTS
Cgluc-strip showed the poorest correlation (r = 0.8289) and agreement (-9.87 +/- 31.76). It exceeded the limits of acceptable variation of the Clinical and Laboratory Standards Institute in 23.7% of the cases, and was higher than Agluc-lab in 90% of the measurements. Agluc-strip showed the best correlation (r = 0.9406), with agreement of -6.75 +/- 19.07 and significant variation in 7.9%. For Vgluc-lab, r = 0.8549, with agreement of -4.20 +/- 28.37 and significant variation in 15.7%. Significant variation was more frequent in patients on noradrenalin (36.4% versus 6.3%; P = 0.03) but not in the subgroup with hypoperfusion. There was discordance regarding clinical management in 25%, 22% and 15% of the cases for Cgluc-strip, Vgluc-lab and Agluc-strip, respectively.


CONCLUSIONS
Cgluc-strip should be avoided, particularly if noradrenalin is being used. This method usually overestimates the true glucose levels and gives rise to management errors.


BACKGROUND
ACTRN12608000513314 (registered as an observational, cross-sectional study).
Pulzi Júnior
Sérgio Antônio
SA
Intensive Care Sector, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Assunção
Murillo Santucci Cesar de
MS
Mazza
Bruno Franco
BF
Fernandes
Haggéas da Silveira
Hda S
Jackiu
Mirian
M
Freitas
Flávio Geraldo Resende
FG
Machado
Flávia Ribeiro
FR
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D002196:Capillaries; D002648:Child; D003124:Colorimetry / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D011934:Reagent Strips; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D001786:Blood Glucose; D011934:Reagent Strips; D014662:Vasoconstrictor Agents; D009638:Norepinephrine