Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit.
BACKGROUND
Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis.


OBJECTIVE
To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock.


METHODS
Retrospective and exploratory study that involved collection of patients' sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions.


RESULTS
Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died during the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions.


CONCLUSIONS
Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes.
Fundamental Nursing Program, College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil. Electronic address: lauramsilveira@yahoo.com.br.
L M
LM
Silveira
Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
A
A
Basile-Filho
Division of Intensive Care, Department of Surgery and Anatomy, Hospital of the Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
E A
EA
Nicolini
Department of General and Specialized Nursing, College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
C A M
CAM
Dessotte
College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
G C S
GCS
Aguiar
College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil. Electronic address: angelita@eerp.usp.br.
A M
AM
Stabile
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000175:diagnosis / Q000451:nursing; D003920:Diabetes Mellitus / Q000451:nursing / Q000503:physiopathology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000451:nursing; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology*; D011795:Surveys and Questionnaires
D001786:Blood Glucose
Glycaemic lability; Glycaemic variability; Sepsis; Sepsis shock; Severe sepsis; Unit care