Hypoglycemia and outcome in critically ill patients.
OBJECTIVE
To determine whether mild or moderate hypoglycemia that occurs in critically ill patients is independently associated with an increased risk of death.


METHODS
Of patients admitted to 2 hospital intensive care units (ICUs) in Melbourne and Sydney, Australia, from January 1, 2000, to October 14, 2004, we analyzed all those who had at least 1 episode of hypoglycemia (glucose concentration, <81 mg/dL). The independent association between hypoglycemia and outcome was statistically assessed.


RESULTS
Of 4946 patients admitted to the ICUs, a cohort of 1109 had at least 1 episode of hypoglycemia (blood glucose level, <81 mg/dL). Of these 1109 patients (22.4% of all admissions to the intensive care unit), hospital mortality was 36.6% compared with 19.7% in the 3837 nonhypoglycemic control patients (P<.001). Even patients with a minimum blood glucose concentration between 72 and 81 mg/dL had a greater unadjusted mortality rate than did control patients (25.9% vs 19.7%; unadjusted odds ratio, 1.42; 95% confidence interval, 1.12-1.80; P=.004.) Mortality increased significantly with increasing severity of hypoglycemia (P<.001). After adjustment for insulin therapy, hypoglycemia was independently associated with increased risk of death, cardiovascular death, and death due to infectious disease.


CONCLUSIONS
In critically ill patients, an association exists between even mild or moderate hypoglycemia and mortality. Even after adjustment for insulin therapy or timing of hypoglycemic episode, the more severe the hypoglycemia, the greater the risk of death.
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
Taori
Gopal
G
Hegarty
Colin
C
Bailey
Michael
M
D001786:Blood Glucose / Q000032:analysis*; D002423:Cause of Death / Q000639:trends; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014739:Victoria / Q000453:epidemiology
D001786:Blood Glucose