Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization
BackgroundThere was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This retrospective cohort study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the opti...
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.857368/full |
| _version_ | 1818015540847837184 |
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| author | Zongqing Lu Zongqing Lu Gan Tao Gan Tao Xiaoyu Sun Xiaoyu Sun Yijun Zhang Yijun Zhang Mengke Jiang Mengke Jiang Yu Liu Meng Ling Meng Ling Jin Zhang Jin Zhang Wenyan Xiao Wenyan Xiao Tianfeng Hua Tianfeng Hua Huaqing Zhu Min Yang Min Yang |
| author_facet | Zongqing Lu Zongqing Lu Gan Tao Gan Tao Xiaoyu Sun Xiaoyu Sun Yijun Zhang Yijun Zhang Mengke Jiang Mengke Jiang Yu Liu Meng Ling Meng Ling Jin Zhang Jin Zhang Wenyan Xiao Wenyan Xiao Tianfeng Hua Tianfeng Hua Huaqing Zhu Min Yang Min Yang |
| author_sort | Zongqing Lu |
| collection | DOAJ |
| description | BackgroundThere was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This retrospective cohort study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the optimal MBG range.MethodsSepsis patients were enrolled from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). MBG and glycemic coefficient of variation (GluCV) were, respectively, calculated to represent the overall glycemic status and GV during ICU stay. The associations between MBG, GluCV, and ICU mortality of the septic patients were assessed by using multivariate logistic regression in different subgroups and the severity of sepsis. Restricted cubic splines evaluated the optimal MBG target.ResultsA total of 7,104 adult sepsis patients were included. The multivariate logistic regression results showed that increased MBG and GluCV were significantly correlated with ICU mortality. The adjusted odds ratios were 1.14 (95% CI 1.09–1.20) and 1.05 (95% CI 1.00–1.12). However, there was no association between hyperglycemia and ICU mortality among diabetes, liver disease, immunosuppression, and hypoglycemia patients. And the impact of high GluCV on ICU mortality was not observed in those with diabetes, immunosuppression, liver disease, and non-septic shock. The ICU mortality risk of severe hyperglycemia (≧200 mg/dl) and high GluCV (>31.429%), respectively, elevated 2.30, 3.15, 3.06, and 2.37, 2.79, 3.14-folds in mild (SOFA ≦ 3), middle (SOFA 3–7), and severe group (SOFA ≧ 7). The MBG level was associated with the lowest risk of ICU mortality and hypoglycemia between 120 and 140 mg/dl in the subgroup without diabetes. For the diabetic subset, the incidence of hypoglycemia was significantly reduced when the MBG was 140–190 mg/dl, but a glycemic control target effectively reducing ICU mortality was not observed.ConclusionMBG and GluCV during the ICU stay were associated with all-cause ICU mortality in sepsis patients; however, their harms are not apparent in some particular subgroups. The impact of hyperglycemia and high GV on death increased with the severity of sepsis. The risk of ICU mortality and hypoglycemia in those with no pre-existing diabetes was lower when maintaining the MBG in the range of 120–140 mg/dl. |
| first_indexed | 2024-04-14T06:58:33Z |
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| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-14T06:58:33Z |
| publishDate | 2022-04-01 |
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| spelling | doaj.art-dd2d85254cbd45bdadc71a9f45cba6432022-12-22T02:06:49ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-04-011010.3389/fpubh.2022.857368857368Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU HospitalizationZongqing Lu0Zongqing Lu1Gan Tao2Gan Tao3Xiaoyu Sun4Xiaoyu Sun5Yijun Zhang6Yijun Zhang7Mengke Jiang8Mengke Jiang9Yu Liu10Meng Ling11Meng Ling12Jin Zhang13Jin Zhang14Wenyan Xiao15Wenyan Xiao16Tianfeng Hua17Tianfeng Hua18Huaqing Zhu19Min Yang20Min Yang21The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaKey Laboratory of Intelligent Computing and Signal Processing, Anhui University, Ministry of Education, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaLaboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, ChinaThe Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaThe Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, ChinaBackgroundThere was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This retrospective cohort study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the optimal MBG range.MethodsSepsis patients were enrolled from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). MBG and glycemic coefficient of variation (GluCV) were, respectively, calculated to represent the overall glycemic status and GV during ICU stay. The associations between MBG, GluCV, and ICU mortality of the septic patients were assessed by using multivariate logistic regression in different subgroups and the severity of sepsis. Restricted cubic splines evaluated the optimal MBG target.ResultsA total of 7,104 adult sepsis patients were included. The multivariate logistic regression results showed that increased MBG and GluCV were significantly correlated with ICU mortality. The adjusted odds ratios were 1.14 (95% CI 1.09–1.20) and 1.05 (95% CI 1.00–1.12). However, there was no association between hyperglycemia and ICU mortality among diabetes, liver disease, immunosuppression, and hypoglycemia patients. And the impact of high GluCV on ICU mortality was not observed in those with diabetes, immunosuppression, liver disease, and non-septic shock. The ICU mortality risk of severe hyperglycemia (≧200 mg/dl) and high GluCV (>31.429%), respectively, elevated 2.30, 3.15, 3.06, and 2.37, 2.79, 3.14-folds in mild (SOFA ≦ 3), middle (SOFA 3–7), and severe group (SOFA ≧ 7). The MBG level was associated with the lowest risk of ICU mortality and hypoglycemia between 120 and 140 mg/dl in the subgroup without diabetes. For the diabetic subset, the incidence of hypoglycemia was significantly reduced when the MBG was 140–190 mg/dl, but a glycemic control target effectively reducing ICU mortality was not observed.ConclusionMBG and GluCV during the ICU stay were associated with all-cause ICU mortality in sepsis patients; however, their harms are not apparent in some particular subgroups. The impact of hyperglycemia and high GV on death increased with the severity of sepsis. The risk of ICU mortality and hypoglycemia in those with no pre-existing diabetes was lower when maintaining the MBG in the range of 120–140 mg/dl.https://www.frontiersin.org/articles/10.3389/fpubh.2022.857368/fullsepsisglucose metabolism disordersmortalityrestricted cubic splines regressionglycemic control |
| spellingShingle | Zongqing Lu Zongqing Lu Gan Tao Gan Tao Xiaoyu Sun Xiaoyu Sun Yijun Zhang Yijun Zhang Mengke Jiang Mengke Jiang Yu Liu Meng Ling Meng Ling Jin Zhang Jin Zhang Wenyan Xiao Wenyan Xiao Tianfeng Hua Tianfeng Hua Huaqing Zhu Min Yang Min Yang Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization Frontiers in Public Health sepsis glucose metabolism disorders mortality restricted cubic splines regression glycemic control |
| title | Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization |
| title_full | Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization |
| title_fullStr | Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization |
| title_full_unstemmed | Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization |
| title_short | Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization |
| title_sort | association of blood glucose level and glycemic variability with mortality in sepsis patients during icu hospitalization |
| topic | sepsis glucose metabolism disorders mortality restricted cubic splines regression glycemic control |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.857368/full |
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