Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis

a 3-year retrospective observational study

Sunghoon Park, Dong Gyu Kim, Gee Y. Suh, Jun G. Kang, Young Su Ju, Yongjae Lee, Ji Y. Park, Seok W. Lee, Ki Suck Jung

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Introduction: Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited.Methods: Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated.Results: Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6%) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7%) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9%) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2% vs. 15.6%, P = 0.003; cardiac, 31.9% vs. 14.3%, P = 0.008; hepatic, 34.0% vs. 18.2%, P = 0.024; bacteremia, 14.9% vs. 4.5%, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95% confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95% confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001).Conclusion: Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.

Original languageEnglish
Article numberR189
JournalCritical Care
Volume16
Issue number5
DOIs
Publication statusPublished - 2012 Oct 12

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Hypoglycemia
Observational Studies
Sepsis
Retrospective Studies
Mortality
Blood Glucose
Hypoglycemic Agents
Hospital Mortality
Odds Ratio
Confidence Intervals
Glucose
Kaplan-Meier Estimate
Hematologic Tests
Bacteremia
Critical Illness
Multivariate Analysis
Survival Rate
Guidelines
Physicians
Kidney

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Park, Sunghoon ; Kim, Dong Gyu ; Suh, Gee Y. ; Kang, Jun G. ; Ju, Young Su ; Lee, Yongjae ; Park, Ji Y. ; Lee, Seok W. ; Jung, Ki Suck. / Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis : a 3-year retrospective observational study. In: Critical Care. 2012 ; Vol. 16, No. 5.
@article{b23a22f270944b629a1a8e3c6264b076,
title = "Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis: a 3-year retrospective observational study",
abstract = "Introduction: Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited.Methods: Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated.Results: Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6{\%}) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7{\%}) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9{\%}) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2{\%} vs. 15.6{\%}, P = 0.003; cardiac, 31.9{\%} vs. 14.3{\%}, P = 0.008; hepatic, 34.0{\%} vs. 18.2{\%}, P = 0.024; bacteremia, 14.9{\%} vs. 4.5{\%}, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95{\%} confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95{\%} confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001).Conclusion: Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.",
author = "Sunghoon Park and Kim, {Dong Gyu} and Suh, {Gee Y.} and Kang, {Jun G.} and Ju, {Young Su} and Yongjae Lee and Park, {Ji Y.} and Lee, {Seok W.} and Jung, {Ki Suck}",
year = "2012",
month = "10",
day = "12",
doi = "10.1186/cc11674",
language = "English",
volume = "16",
journal = "Critical Care",
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Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis : a 3-year retrospective observational study. / Park, Sunghoon; Kim, Dong Gyu; Suh, Gee Y.; Kang, Jun G.; Ju, Young Su; Lee, Yongjae; Park, Ji Y.; Lee, Seok W.; Jung, Ki Suck.

In: Critical Care, Vol. 16, No. 5, R189, 12.10.2012.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis

T2 - a 3-year retrospective observational study

AU - Park, Sunghoon

AU - Kim, Dong Gyu

AU - Suh, Gee Y.

AU - Kang, Jun G.

AU - Ju, Young Su

AU - Lee, Yongjae

AU - Park, Ji Y.

AU - Lee, Seok W.

AU - Jung, Ki Suck

PY - 2012/10/12

Y1 - 2012/10/12

N2 - Introduction: Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited.Methods: Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated.Results: Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6%) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7%) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9%) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2% vs. 15.6%, P = 0.003; cardiac, 31.9% vs. 14.3%, P = 0.008; hepatic, 34.0% vs. 18.2%, P = 0.024; bacteremia, 14.9% vs. 4.5%, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95% confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95% confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001).Conclusion: Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.

AB - Introduction: Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited.Methods: Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated.Results: Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6%) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7%) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9%) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2% vs. 15.6%, P = 0.003; cardiac, 31.9% vs. 14.3%, P = 0.008; hepatic, 34.0% vs. 18.2%, P = 0.024; bacteremia, 14.9% vs. 4.5%, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95% confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95% confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001).Conclusion: Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.

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U2 - 10.1186/cc11674

DO - 10.1186/cc11674

M3 - Article

VL - 16

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 5

M1 - R189

ER -