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

• Published in: Critical care (London, England) Vol. 19; no. 1; p. 153
• Main Authors: Kalfon, Pierre, Le Manach, Yannick, Ichai, Carole, Bréchot, Nicolas, Cinotti, Raphaël, Dequin, Pierre-François, Riu-Poulenc, Béatrice, Montravers, Philippe, Annane, Djilalli, Dupont, Hervé, Sorine, Michel, Riou, Bruno
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.04.2015; BioMed Central
• Subjects: Automatic Control Engineering; Blood Glucose - analysis; Computer Science; Critical care; Critically ill; Diagnosis; Drug Therapy, Computer-Assisted; Female; Hospital Mortality; Human health and pathology; Humans; Hyperglycemia - drug therapy; Hyperglycemia - physiopathology; Hypoglycemia; Hypoglycemia - mortality; Hypoglycemic Agents - administration & dosage; Insulin - administration & dosage; Insulin resistance; Intensive care; Intensive Care Units; Life Sciences; Male; Middle Aged; Mortality; Multivariate Analysis; Patient outcomes; Severity of Illness Index; Stress, Physiological - physiology; France
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-015-0851-7

In a randomized controlled trial comparing tight glucose control with a computerized decision support system and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity. We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) hypoglycemia, multiple hypoglycemic events (n ≥3) and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary endpoint 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 10(-5) digit with no replacement). 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 (odds ratio (OR), 1.50; 95% CI, 1.36 to 1.56; P =0.043) and multiple hypoglycemic events (OR, 1.76, 95% CI, 1.31 to 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. In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality. Clinicaltrials.gov Identifier: NCT01002482 . Registered 26 October 2009.