title: Which variables are associated with blood glucose levels outside the target range in surgical critically ill patients? A retrospective observational study.
abstract: BACKGROUND
  The aim of the present study is to determine the variables affecting blood glucose concentrations outside the target range of 80 and 150 mg/dl in critically ill surgical patients.
  
  
  METHODS
  All critically ill surgical patients admitted to a university ICU, from 01/2007 to 12/2008, were surveyed daily using computer assistance with respect to minimal and maximal daily blood glucose concentrations, application of insulin and demographic/clinical variables. Multiple logistic regression for clustered data with backward elimination was performed to identify variables strongly associated with blood glucose concentrations < 80 mg/dl or ≥ 150 mg/dl in 804 patients with an ICU stay > 72 hours.
  
  
  RESULTS
  Application of insulin (odds ratio (OR) 2.1, with corresponding 95% confidence interval (CI) 1.7; 2.6), noradrenaline (OR 1.4, 95% CI 1.2 - 1.8) or steroids (1.3, 1.003 - 1.7), and age (per year) (1.02, 1.01 - 1.03) were associated with an increased risk of blood glucose concentrations < 80 mg/dl. In analogy, application of insulin (OR 2.4, 95% CI 2.0 - 2.7), noradrenaline (1.4, 1.2 - 1.6) or steroids (1.4, 1.2 - 1.7), severe sepsis (1.2, 1.1 - 1.4), neurosurgery (OR 1.0) compared to abdominal, vascular and trauma surgery, and age (per year) (1.01, 1.01 - 1.02), were associated with an increased risk of blood glucose concentrations ≥ 150 mg/dl.
  
  
  CONCLUSIONS
  Critically ill surgical patients are at an increased risk for fluctuating blood glucose concentrations ranging < 80 mg/dl or ≥ 150 mg/dl in particular if they are of advanced age and require administration of insulin, noradrenaline, and/or steroids. Patients who underwent neurosurgery and/or presented with severe sepsis/shock are those in particular at risk for blood glucose concentrations ≥ 150 mg/dl.
authors.affiliation: Department of Anaesthesiology, University Hospital Medical School Ulm, Steinhoevelstr, 9, 89075 Ulm, Germany. manfred.weiss@uniklinik-ulm.de.
authors.forename: Manfred
authors.initials: M
authors.lastname: Weiss
authors.forename: Martina
authors.initials: M
authors.lastname: Kron
authors.forename: Birgit
authors.initials: B
authors.lastname: Hay
authors.forename: Michael
authors.initials: M
authors.lastname: Taenzer
authors.forename: Peter
authors.initials: P
authors.lastname: Radermacher
authors.forename: Michael
authors.initials: M
authors.lastname: Georgieff