Admission Hyperglycemia and Other Risk Factors as Predictors of Hospital Mortality in a Medical ICU Population

• Published in: Chest Vol. 128; no. 5; pp. 3109 - 3116
• Main Authors: Freire, Amado X., Bridges, Lisa, Umpierrez, Guillermo E., Kuhl, David, Kitabchi, Abbas E.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.11.2005; American College of Chest Physicians
• Subjects: Acidosis, Lactic - epidemiology; African Americans; Aged; APACHE; APACHE = acute physiology and chronic health evaluation; Biological and medical sciences; CABG = coronary artery bypass graft; Cardiology. Vascular system; Confidence intervals; Coronary vessels; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic ketoacidosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glucose; Heart attacks; Heart surgery; Hospital Mortality; Hospitals; Humans; Hyperglycemia; Hyperglycemia - epidemiology; Hypoalbuminemia - epidemiology; ICU; Inner city; Insulin; Intensive Care Units; Length of Stay; Lifesaving; LODS = logistic organ dysfunction system; Logistic Models; LOS = length of stay; Male; Medical sciences; MICU = medical ICU; Middle Aged; Mortality; Physiology; Pneumology; Prospective Studies; Respiration, Artificial; Risk Factors; SICU = surgical ICU; SMR = standardized mortality ratio; TISS = therapeutic intervention scoring system; Urban Population; Ventilators; insulin; SICU = surgical ICU; APACHE = acute physiology and chronic health evaluation; TISS = therapeutic intervention scoring system; hyperglycemia; SMR = standardized mortality ratio; CABG = coronary artery bypass graft; MICU = medical ICU; LODS = logistic organ dysfunction system; ICU; LOS = length of stay; diabetes; hospital mortality; Endocrinopathy; Prognosis; Respiratory disease; Predictor; Diabetes mellitus; Mortality; Prediction; Cardiovascular disease; Epidemiology; Insulin; Medicine; Hyperglycemia; Risk factor; Population; Hospital; Predictive factor
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.128.5.3109

Background: Tight glycemic control is recommended for patients in the ICU, as hyperglycemia is associated with increased morbidity and mortality. Design: Observational cohort of patients admitted to a 12-bed, inner-city, medical ICU (MICU). Subjects: A total of 1,185 of 1,506 patients from July 1, 1999, to December 31, 2002, selected based on a diagnosis other than diabetic ketoacidosis or glycemia > 280 mg/dL or < 80 mg/dL. Purpose: To determine if the highest serum glucose level within 24 h after ICU admission is associated with increased hospital mortality when adjusted for confounders. Measurements: Age, gender, race, worst values within 24 h after ICU admission to construct the acute physiology and chronic health evaluation (APACHE) II score, and highest glucose within 24 h after ICU admission. Hospital mortality was the primary outcome. Admitting diagnosis, MICU length of stay (LOS), and hospital LOS were obtained. Glucose, albumin (n = 867), and lactic acid (n = 319) were stratified for analysis. Analysis: Univariate analysis identified factors included in the multivariate model. Results: Patients were predominantly African-American (79%) and men (56%; mean age, 49.2 years). The mean ICU admission highest glucose level was 139 ± 43.7 mg/dL (± SD). MICU LOS and hospital LOS were 6.2 days and 12.9 days, respectively, and 50% of patients received mechanical ventilation. MICU and hospital mortality were 18% and 20%, respectively; standardized mortality ratio was 66%. On univariate analysis, survivors (n = 945) and nonsurvivors (n = 240) showed APACHE II score, mechanical ventilation, hypoalbuminemia, lactic acidemia, and logistic organ dysfunction system score to be hospital mortality predictors; however, the highest admission serum glucose level was not. Logistic regression estimated APACHE II score/per point (odds ratio, 1.06; 95% confidence interval, 1.02 to 1.11), mechanical ventilation (odds ratio, 3.06; 95% confidence interval, 1.34 to 6.96), severe hypoalbuminemia (< 2 g/dL) [odds ratio, 2.98; 95% confidence interval, 1.3 to 7.02], and severe lactic acidemia (≥ 8 mmol/L) [odds ratio, 7.3; 95% confidence interval, 2.14 to 24.9], but not ICU admission hyperglycemia, to be associated with hospital mortality. Conclusions: Conventional factors of disease severity, but not highest glucose value during the first 24 h after ICU admission, predict hospital mortality in an inner-city MICU.