The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study
Abstract Background We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality. Methods For this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 20...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2019-02-01
|
| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-019-0507-x |
| _version_ | 1818389585113120768 |
|---|---|
| author | Sigrid C. van Steen Saskia Rijkenberg Peter H. J. van der Voort J. Hans DeVries |
| author_facet | Sigrid C. van Steen Saskia Rijkenberg Peter H. J. van der Voort J. Hans DeVries |
| author_sort | Sigrid C. van Steen |
| collection | DOAJ |
| description | Abstract Background We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality. Methods For this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 2017. We excluded patients admitted < 24 h, patients with a diabetic ketoacidosis, patients with a therapy restriction upon ICU admission and readmissions. Using multivariate logistic regression, we examined the relation between intravenous insulin and glucose infusion and ICU and hospital mortality for all patients. Additionally, we used the same model to analyze the outcomes for patients admitted > 72 h. Results Of 9507 eligible patients, 3966 were included. After correction for potential confounders, intravenous insulin was associated with ICU and hospital mortality in patients admitted > 24 h (n = 3966) (odds ratio (OR) 1.09 [95% CI 1.05–1.13] and 1.09 [95% CI 1.06–1.13] per 0.1 IU/kg added, respectively). Likewise, intravenous glucose was associated with ICU mortality (OR 1.01 [95% CI 1.00–1.01]) but not with hospital mortality and (OR 1.00 [95% CI 1.00–1.01]) per g/day added, respectively. In patients admitted > 72 h (n = 1550), insulin dose was associated with both ICU and hospital mortality (p = 0.002 and p < 0.001, respectively), but glucose infusion was not (p = 0.08 and p = 0.2, respectively). Conclusions Intravenous insulin administration is associated with an increased risk of ICU and hospital mortality, after correction for potential confounders. Parenteral glucose administration was limited in amount but was still associated with ICU mortality. However, based on these results, it is unknown whether this association is an epiphenomenon, or represents a true harm of insulin and glucose administration. |
| first_indexed | 2024-12-14T04:44:04Z |
| format | Article |
| id | doaj.art-6cb44ea9ced04658820f9fdc66732b18 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-14T04:44:04Z |
| publishDate | 2019-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6cb44ea9ced04658820f9fdc66732b182022-12-21T23:16:44ZengSpringerOpenAnnals of Intensive Care2110-58202019-02-019111210.1186/s13613-019-0507-xThe association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective studySigrid C. van Steen0Saskia Rijkenberg1Peter H. J. van der Voort2J. Hans DeVries3Department of Endocrinology, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care, OLVG HospitalDepartment of Intensive Care, OLVG HospitalDepartment of Endocrinology, Amsterdam UMC, University of AmsterdamAbstract Background We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality. Methods For this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 2017. We excluded patients admitted < 24 h, patients with a diabetic ketoacidosis, patients with a therapy restriction upon ICU admission and readmissions. Using multivariate logistic regression, we examined the relation between intravenous insulin and glucose infusion and ICU and hospital mortality for all patients. Additionally, we used the same model to analyze the outcomes for patients admitted > 72 h. Results Of 9507 eligible patients, 3966 were included. After correction for potential confounders, intravenous insulin was associated with ICU and hospital mortality in patients admitted > 24 h (n = 3966) (odds ratio (OR) 1.09 [95% CI 1.05–1.13] and 1.09 [95% CI 1.06–1.13] per 0.1 IU/kg added, respectively). Likewise, intravenous glucose was associated with ICU mortality (OR 1.01 [95% CI 1.00–1.01]) but not with hospital mortality and (OR 1.00 [95% CI 1.00–1.01]) per g/day added, respectively. In patients admitted > 72 h (n = 1550), insulin dose was associated with both ICU and hospital mortality (p = 0.002 and p < 0.001, respectively), but glucose infusion was not (p = 0.08 and p = 0.2, respectively). Conclusions Intravenous insulin administration is associated with an increased risk of ICU and hospital mortality, after correction for potential confounders. Parenteral glucose administration was limited in amount but was still associated with ICU mortality. However, based on these results, it is unknown whether this association is an epiphenomenon, or represents a true harm of insulin and glucose administration.http://link.springer.com/article/10.1186/s13613-019-0507-xInsulinGlucoseHyperglycemiaGlycemic controlCritical illnessIntensive care unit |
| spellingShingle | Sigrid C. van Steen Saskia Rijkenberg Peter H. J. van der Voort J. Hans DeVries The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study Annals of Intensive Care Insulin Glucose Hyperglycemia Glycemic control Critical illness Intensive care unit |
| title | The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study |
| title_full | The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study |
| title_fullStr | The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study |
| title_full_unstemmed | The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study |
| title_short | The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study |
| title_sort | association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality a retrospective study |
| topic | Insulin Glucose Hyperglycemia Glycemic control Critical illness Intensive care unit |
| url | http://link.springer.com/article/10.1186/s13613-019-0507-x |
| work_keys_str_mv | AT sigridcvansteen theassociationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT saskiarijkenberg theassociationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT peterhjvandervoort theassociationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT jhansdevries theassociationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT sigridcvansteen associationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT saskiarijkenberg associationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT peterhjvandervoort associationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy AT jhansdevries associationofintravenousinsulinandglucoseinfusionwithintensivecareunitandhospitalmortalityaretrospectivestudy |