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

Abstract : Introduction Using a randomized controlled trial comparing tight glucose control with a computerized decision-support systems 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 (2.2-3.3mmol/l) and severe (<2.2mmol/l) hypoglycemia, multiple hypoglycemic events (n[greater than or equal to]3), and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary end-point 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 105 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 (OR 1.50, 95% CI 1.36-1.56, P=0.043) and multiple hypoglycemic events (OR 1.76, 95% CI 1.31-3.37, 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 Octobrer 2009.
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Pierre Kalfon, Yannick Le Manach, Carole Ichai, Nicolas Brechot, Raphaël Cinotti, et al.. Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients. Critical Care, BioMed Central, 2015, 19 (1), pp.153. ⟨10.1186/s13054-015-0851-7⟩. ⟨hal-01217313⟩

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