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Glycemic lability index and mortality in critically ill patients—A multicenter cohort study
Author(s) -
Hanna Michel,
Balintescu Anca,
Glassford Neil,
Lipcsey Miklos,
Eastwood Glenn,
Oldner Anders,
Bellomo Rinaldo,
Mårtensson Johan
Publication year - 2021
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13843
Subject(s) - medicine , hypoglycemia , glycemic , odds ratio , intensive care unit , diabetes mellitus , cohort , glycated hemoglobin , cohort study , retrospective cohort study , glycemic index , type 2 diabetes , insulin , endocrinology
Background Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship. Methods In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time‐weighted average blood glucose (TWA‐BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA‐BG (above vs. below cohort median) with hospital mortality. Results Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L] 2 /h/week, median TWA‐BG was 8.2 mmol/L, 171 (7%) developed hypoglycemia, and 371 (16%) died. The adjusted odds ratio for death was 1.61 (95% CI, 1.19‐2.15; P = .002) for GLI above versus below median and 1.06 (95% CI, 0.80‐1.41; P = .67) for TWA‐BG above versus below median. The relationship between GLI and mortality was not modified by TWA‐BG ( P [interaction] = 0.66), a history of diabetes ( P [interaction] = 0.89) or by HbA1c ≥52 mmol/mol (vs. <52 mmol/mol) ( P [interaction] = 0.29). Conclusion In adult patients admitted to an ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.