Average daily risk range as a measure of glycemic risk is associated with mortality in the intensive care unit: a retrospective study in a burn intensive care unit.
BACKGROUND
Although tight glycemic control has been associated with improved outcomes in the intensive care unit (ICU), glycemic variability may be the influential factor in mortality. The main goal of the study was to relate blood glucose (BG) variability of burn ICU patients to outcomes using a sensitive measure of glycemic variability, the average daily risk range (ADRR).


METHODS
Data from patients admitted to a burn ICU were used. Patients were matched by total body surface area (TBSA) and injury severity score (ISS) to test whether increased BG variability measured by ADRR was associated with higher mortality risk and whether we could identify ADRR-based classifications associated with the degree of risk.


RESULTS
Four ADRR classifications were identified: low risk, medium-low, medium-high, and high. Mortality progressively increased from 25% in the low-risk group to over 60% in the high-risk group (p < .001). In a post hoc analysis, age also contributed to outcome. Younger (age < 43 years) survivors and nonsurvivors matched by TBSA and ISS had no significant difference in age, mean BG or standard deviation of BG; however, nonsurvivors had higher ADRR (p < .01).


CONCLUSIONS
Independent of injury severity, glycemic variability measured by the ADRR was significantly associated with mortality in the ICU. When age was considered, ADRR was the only measure of glycemia significantly associated with mortality in younger patients with burns.
University of Virginia Health System, Charlottesville, Virginia 22908, USA. leon@virginia.edu
Leon S
LS
Farhy
Edward A
EA
Ortiz
Boris P
BP
Kovatchev
Alejandra G
AG
Mora
Steven E
SE
Wolf
Charles E
CE
Wade
D000328:Adult; D000367:Age Factors; D000368:Aged; D001786:Blood Glucose; D002056:Burns / Q000401:mortality*; D003422:Critical Care; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk
D001786:Blood Glucose