title: Glycaemic variability, infections and mortality in a medical-surgical intensive care unit.
abstract: OBJECTIVE
  In critically ill patients, glycaemic variability (GV) was reported as a better predictor of mortality than mean blood glucose level (BGL). We compared the ability of different GV indices and mean BGLs to predict mortality and intensive care unit-acquired infections in a population of ICU patients.
  
  
  METHODS
  Retrospective study on adult ICU patients with ≥ three BGL measurements. GV was assessed by SD, coefficient of variation (CV) and mean amplitude of glycaemic excursion (MAGE), and by one timeweighted index, the glycaemic lability index (GLI), and compared with mean BGL. We studied 2782 patients admitted to the 12-bed medical-surgical ICU of a teaching hospital from January 2004 until December 2010.
  
  
  METHODS
  Logistic regression analyses were performed to assess the association between GV and ICU mortality and ICU-acquired infections. The areas under receiver operating characteristic curves were calculated to compare the discriminatory ability of GV and mean BGL for infections and mortality.
  
  
  RESULTS
  Mortality was 16.6%, and 30% of patients had at least one infection. Patients with infections or diabetes or who were treated with insulin had a higher mean BGL and GV than other patients. GLI, SD, CV and MAGE were significantly associated with infections and mortality; mean BGL was not. Quartiles of increasing GLI were independently associated with higher mortality and an increased infection rate. Patients in the upper quartile of mean BGL and GLI had the strongest association with infections (odds ratio, 5.044 [95% CI, 1.695-15.007]; P = 0.004).
  
  
  CONCLUSIONS
  High GV is associated with higher risk of ICUCrit acquired infection and mortality.
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy. a.donati@univpm.it.
authors.forename: Abele
authors.initials: A
authors.lastname: Donati
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Damiani
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Domizi
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Botticelli
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Castagnani
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gabbanelli
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Nataloni
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carsetti
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Scorcella
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Adrario
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelaia
authors.affiliation: Department of General Intensive Care, Erasme University Hospital, Brussels, Belgium.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Preiser
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D016638:Critical Illness / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D001786:Blood Glucose