title: Optimal target range for blood glucose in hyperglycaemic patients in a neurocritical care unit.
abstract: BACKGROUND
  Hyperglycaemia is common among patients with critical neurological injury, even if they have no history of diabetes. The optimal target range for normalizing their blood glucose is unknown.
  
  
  METHODS
  Retrospective data were extracted from 890 hyperglycaemic individuals (glucose > 200 mg/dL) admitted to neuroscience critical care unit (NCCU) and these patients were divided into two groups: intensive glucose control group with target glucose of < 140 mg/dL achieved and moderate control with glucose levels 140-180 mg/dL. The groups were also stratified according to the hyperglycaemia type (pre-existing diabetes or stress-related). We defined the primary endpoint as death from any cause during NCCU admission.
  
  
  RESULTS
  In NCCU, tighter control of blood glucose at ≤ 140 mg/dL was associated with increased, mortality of individuals with pre-existing diabetes compared with moderate control [29 of 310 patients (9.4%) vs 15 of 304 patients (4.9%), p = 0.034]. Patient age [adjusted odds ratio (OR) = 1.12; 95% confidence interval (CI) = 1.05-1.19; p < 0.001], level of glycated haemoglobin (adjusted OR = 1.24; 95% CI = 1.04-1.48; p = 0.017) and hypoglycaemia (adjusted OR = 10.3; 95% CI = 2.92-36.6; p < 0.001) were positively associated with higher mortality. Death rate was lower among stress-related hyperglycaemic patients with tighter glucose controlled at ≤ 140 mg/dL [6 of 140 patients (4.3%) vs 15 of 136 patients (11.0%), p = 0.035].
  
  
  CONCLUSIONS
  A differential association is evident between glucose levels and mortality in diabetes and stress-related hyperglycaemia patients. However, given the observational nature of our work, no clinical recommendations can be given and prospective studies are required to further investigate these findings.
authors.affiliation: Department of Neurology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Guo
authors.affiliation: Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Neurology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
authors.forename: Sheng-Yi
authors.initials: SY
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
authors.forename: Wen-Qing
authors.initials: WQ
authors.lastname: Xia
authors.affiliation: Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China gyjwsh@yahoo.cn.
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D016009:Chi-Square Distribution; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Hyperglycaemia; critical care; mortality; neurosciences