title: Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study.
abstract: BACKGROUND
  Hyperglycemia, hypoglycemia, and increased glycemic variability have each been independently associated with increased risk of mortality in critically ill patients. The role of diabetic status on modulating the relation of these three domains of glycemic control with mortality remains uncertain. The purpose of this investigation was to determine how diabetic status affects the relation of hyperglycemia, hypoglycemia, and increased glycemic variability with the risk of mortality in critically ill patients.
  
  
  METHODS
  This is a retrospective analysis of prospectively collected data involving 44,964 patients admitted to 23 intensive care units (ICUs) from nine countries, between February 2001 and May 2012. We analyzed mean blood glucose concentration (BG), coefficient of variation (CV), and minimal BG and created multivariable models to analyze their independent association with mortality. Patients were stratified according to the diagnosis of diabetes.
  
  
  RESULTS
  Among patients without diabetes, mean BG bands between 80 and 140 mg/dl were independently associated with decreased risk of mortality, and mean BG bands>or=140 mg/dl, with increased risk of mortality. Among patients with diabetes, mean BG from 80 to 110 mg/dl was associated with increased risk of mortality and mean BG from 110 to 180 mg/dl with decreased risk of mortality. An effect of center was noted on the relation between mean BG and mortality. Hypoglycemia, defined as minimum BG<70 mg/dl, was independently associated with increased risk of mortality among patients with and without diabetes and increased glycemic variability, defined as CV>or=20%, was independently associated with increased risk of mortality only among patients without diabetes. Derangements of more than one domain of glycemic control had a cumulative association with mortality, especially for patients without diabetes.
  
  
  CONCLUSIONS
  Although hyperglycemia, hypoglycemia, and increased glycemic variability is each independently associated with mortality in critically ill patients, diabetic status modulates these relations in clinically important ways. Our findings suggest that patients with diabetes may benefit from higher glucose target ranges than will those without diabetes. Additionally, hypoglycemia is independently associated with increased risk of mortality regardless of the patient's diabetic status, and increased glycemic variability is independently associated with increased risk of mortality among patients without diabetes.
authors: James S
authors: JS
authors: Krinsley
authors: Moritoki
authors: M
authors: Egi
authors: Alex
authors: A
authors: Kiss
authors: Amin N
authors: AN
authors: Devendra
authors: Philipp
authors: P
authors: Schuetz
authors: Paula M
authors: PM
authors: Maurer
authors: Marcus J
authors: MJ
authors: Schultz
authors: Roosmarijn T M
authors: RT
authors: van Hooijdonk
authors: Morita
authors: M
authors: Kiyoshi
authors: Iain M J
authors: IM
authors: Mackenzie
authors: Djillali
authors: D
authors: Annane
authors: Peter
authors: P
authors: Stow
authors: Stanley A
authors: SA
authors: Nasraway
authors: Sharon
authors: S
authors: Holewinski
authors: Ulrike
authors: U
authors: Holzinger
authors: Jean-Charles
authors: JC
authors: Preiser
authors: Jean-Louis
authors: JL
authors: Vincent
authors: Rinaldo
authors: R
authors: Bellomo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose