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Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients.

Kalfon P, Le Manach Y, Ichai C, Bréchot N, Cinotti R, Dequin PF, Riu-Poulenc B, Montravers P, Annane D, Dupont H, Sorine M, Riou B, CGAO-REA Study Gro - Crit Care (2015)

Bottom Line: We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10(-5) digit with no replacement).Using multivariable matching, patients with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality.In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.

View Article: PubMed Central - PubMed

Affiliation: Service de Réanimation polyvalente, Hôpital Louis Pasteur, CH de Chartres, 34 , avenue du Docteur Maunoury, 28000, Chartres, France. pkalfon@ch-chartres.fr.

ABSTRACT

Introduction: In a randomized controlled trial comparing tight glucose control with a computerized decision support system and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity.

Methods: We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) hypoglycemia, multiple hypoglycemic events (n ≥3) and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary endpoint was 90-day mortality. We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10(-5) digit with no replacement).

Results: A total of 2,601 patients were analyzed and divided into three groups: no hypoglycemia (n =1,474), moderate hypoglycemia (n =874, 34%) and severe hypoglycemia (n =253, 10%). Patients with moderate or severe hypoglycemia had a poorer prognosis, as shown by a higher mortality rate (36% and 54%, respectively, vs. 28%) and decreased number of treatment-free days. In the multivariable analysis, severe (odds ratio (OR), 1.50; 95% CI, 1.36 to 1.56; P =0.043) and multiple hypoglycemic events (OR, 1.76, 95% CI, 1.31 to 3.37; P <0.001) were significantly associated with mortality, whereas blood glucose CV was not. Using multivariable matching, patients with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality.

Conclusion: In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.

Trial registration: Clinicaltrials.gov Identifier: NCT01002482 . Registered 26 October 2009.

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Related in: MedlinePlus

Flowchart of the study.
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Fig1: Flowchart of the study.

Mentions: Among the 2,684 randomized patients, 1,351 were assigned to computerized and 1,333 to conventional blood glucose control. Thirty-six patients were discarded from any analysis, thirty-five of whom withdrew consent and one who was included twice. Among the 2,648 remaining patients, 47 were discarded because important data concerning blood glucose measurement were lacking. Thus, 2,601 patients were analyzed (Figure 1).Figure 1


Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients.

Kalfon P, Le Manach Y, Ichai C, Bréchot N, Cinotti R, Dequin PF, Riu-Poulenc B, Montravers P, Annane D, Dupont H, Sorine M, Riou B, CGAO-REA Study Gro - Crit Care (2015)

Flowchart of the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4470320&req=5

Fig1: Flowchart of the study.
Mentions: Among the 2,684 randomized patients, 1,351 were assigned to computerized and 1,333 to conventional blood glucose control. Thirty-six patients were discarded from any analysis, thirty-five of whom withdrew consent and one who was included twice. Among the 2,648 remaining patients, 47 were discarded because important data concerning blood glucose measurement were lacking. Thus, 2,601 patients were analyzed (Figure 1).Figure 1

Bottom Line: We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10(-5) digit with no replacement).Using multivariable matching, patients with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality.In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.

View Article: PubMed Central - PubMed

Affiliation: Service de Réanimation polyvalente, Hôpital Louis Pasteur, CH de Chartres, 34 , avenue du Docteur Maunoury, 28000, Chartres, France. pkalfon@ch-chartres.fr.

ABSTRACT

Introduction: In a randomized controlled trial comparing tight glucose control with a computerized decision support system and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity.

Methods: We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) hypoglycemia, multiple hypoglycemic events (n ≥3) and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary endpoint was 90-day mortality. We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10(-5) digit with no replacement).

Results: A total of 2,601 patients were analyzed and divided into three groups: no hypoglycemia (n =1,474), moderate hypoglycemia (n =874, 34%) and severe hypoglycemia (n =253, 10%). Patients with moderate or severe hypoglycemia had a poorer prognosis, as shown by a higher mortality rate (36% and 54%, respectively, vs. 28%) and decreased number of treatment-free days. In the multivariable analysis, severe (odds ratio (OR), 1.50; 95% CI, 1.36 to 1.56; P =0.043) and multiple hypoglycemic events (OR, 1.76, 95% CI, 1.31 to 3.37; P <0.001) were significantly associated with mortality, whereas blood glucose CV was not. Using multivariable matching, patients with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality.

Conclusion: In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.

Trial registration: Clinicaltrials.gov Identifier: NCT01002482 . Registered 26 October 2009.

Show MeSH
Related in: MedlinePlus