title: Hypoglycemia at admission is associated with inhospital mortality in Ugandan patients with severe sepsis.
abstract: OBJECTIVE
  Dysglycemia during sepsis is associated with poor outcomes in resource-rich settings. In resource-limited settings, hypoglycemia is often diagnosed clinically without the benefit of laboratory support. We studied the utility of point-of-care glucose monitoring to predict mortality in severely septic patients in Uganda.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  One national and two regional referral hospitals in Uganda.
  
  
  METHODS
  We enrolled 532 patients with sepsis at three hospitals in Uganda. The analysis included 418 patients from the three sites with inhospital mortality data, a documented admission blood glucose concentration, and evidence of organ dysfunction at admission (systolic blood pressure≤100 mm Hg, lactate>4 mmol/L, platelet number<100,000/μL, or altered mental status).
  
  
  METHODS
  None.
  
  
  RESULTS
  We evaluated the association between admission point-of-care blood glucose concentration and inhospital mortality. We also assessed the accuracy of altered mental status as a predictor of hypoglycemia. Euglycemia occurred in 33.5% (140 of 418) of patients, whereas 16.3% (68 of 418) of patients were hypoglycemic and 50.2% (210 of 418) were hyperglycemic. Univariate Cox regression analyses comparing in-hospital mortality among hypoglycemic (35.3% [24 of 68], hazard ratio 2.0, 95% confidence interval 1.2-3.6, p=.013) and hyperglycemic (29.5% [62 of 210], hazard ratio 1.5, 95% confidence interval 0.96-2.4, p=.08) patients to euglycemic (19.3% [27 of 140]) patients showed statistically significantly higher rates of inhospital mortality for patients with hypoglycemia. Hypoglycemia (adjusted hazard ratio 1.9, 95% confidence interval 1.1-3.3, p=.03) remained significantly and independently associated with inhospital mortality in the multivariate model. The sensitivity and specificity of altered mental status for hypoglycemia were 25% and 86%, respectively.
  
  
  CONCLUSIONS
  Hypoglycemia is an independent risk factor for inhospital mortality in patients with severe sepsis and cannot be adequately assessed by clinical examination. Correction of hypoglycemia may improve outcomes of critically ill patients in resource-limited settings.
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Ssekitoleko
authors.forename: Shevin T
authors.initials: ST
authors.lastname: Jacob
authors.forename: Patrick
authors.initials: P
authors.lastname: Banura
authors.forename: Relana
authors.initials: R
authors.lastname: Pinkerton
authors.forename: David B
authors.initials: DB
authors.lastname: Meya
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Nathan
authors.initials: N
authors.lastname: Kenya-Mugisha
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Rose
authors.initials: R
authors.lastname: Muhindo
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhagani
authors.forename: W Michael
authors.initials: WM
authors.lastname: Scheld
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Moore
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000097:blood*; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis*; D014454:Uganda / Q000453:epidemiology
chemical_list: D001786:Blood Glucose