A Retrospective Investigation:the Influence Of Hypoglycemia On Prognosis In Critically Ill Patients

The objective of this investigation was to evaluate the influence of hypoglycemia, defined as a blood glucose concentration (BG)<3.9mmol/l, on prognosis in critically ill patients.Methods:This is a retrospective investigation of prospectively collected data, including199patients admitted to Comprehensive ICU of Union Hospital in Wuhan between September2011and March2012, who had at least three BG values obtained during their ICU stay. Patients admitted during this period with a diagnosis of diabetic ketoacidosis or hyperosmolar nonketotic coma and those enjoying special care were excluded from the present analysis. Patients during the period of investigation were treated with loose glucose control (target BG7.8to10mmol/1).Record general information of patients, APACHE II score during stay in ICU within24hours,ICU stay time and mortality,hospital stay time,mechanical ventilation stayed in ICU,insulin application.Record all BG(blood glucose) measurements and calculate the average blood glucose,blood glucose maximum, blood glucose standard deviation,glucose coefficient of variation.Patients who experienced at least one measurement below3.9mmol/l were divided into hypoglycemia group, others were control group.Results:Of199patients admitted to the ICU, a cohort of35had at least1episode of hypoglycemia (blood glucose level,<3.9mmol/l). The incidence of hypoglycemia was12.6%.Of these35patients, ICU mortality was26.5%compared with7.3%in the164nonhypoglycemic control patients (P<.0.05), CU stay time was6.7±5.74days compared with3.9±5.4days(P<0.05), mechanical ventilation time was104±120days compared with52±105days(P<0.05).There was no difference in hospital stay time,sex, age, mechanical ventilation,insulin application between hypoglycemia group and nonhypoglycemia group, while diagnostic category, admission way, APACHE Ⅱ score, mean BG,BG coefficient of variation(CV) were significantly different. Despite this, patients with hypoglycemia experienced higher mortality than did those without hypoglycemia after stratification by APACHE II score, diagnostic category, admission way,mean BG, BG coefficient of variation. The relative risk (RR,95%confidence interval) of mortality associated with any hypoglycemia<3.9mmol/l,was1.260(1.026to1.549).Conclusion:After adjustment for disease severity, diagnostic category, admission way,mean BG, BG coefficient of variation, even mild or moderate hypoglycemia occurred in critically ill patients with loos glucose control was significantly associated with mortality. In ICU active measures should be taken to reduce the incidence of hypoglycemia.