Analysis of Glycaemic Changes and their Outcome in Critically Ill Non-diabetic Patients Admitted to the ICU: A Cohort Study
Introduction: Critical illness results in physiological and metabolic changes that lead to dysglycaemia, which is associated with morbidity and mortality. There exists a J- or U-shaped relationship between average glucose levels and mortality, emphasising the importance of evaluating glycaemic...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-11-01
|
| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18669/64957_CE[Ra1]_F[SK]_QC(KK_RDW_SS)_PF1(AKA_DK_OM)_PFA_NC(KM)_PN(KM).pdf |
| Summary: | Introduction: Critical illness results in physiological and
metabolic changes that lead to dysglycaemia, which is
associated with morbidity and mortality. There exists a J- or
U-shaped relationship between average glucose levels and
mortality, emphasising the importance of evaluating glycaemic
variability in critical illness.
Aim: To assess glycaemic changes in critically ill patients and
their association with Intensive Care Unit (ICU) outcomes.
Materials and Methods: The prospective cohort study was
conducted from August 2018 to August 2019. A total of 100
non-diabetic critically ill patients admitted to the ICU were
observed for seven days. The severity of illness was evaluated
using the Glasgow Coma Score (GCS) and Sequential Organ
Failure Assessment (SOFA) scores. Plasma glucose levels were
recorded every four hours in the ICU. Patients were followed
for a maximum of seven days or until discharge or death. They
were categorised into hypoglycaemia, normoglycaemia, or
stress hyperglycaemia groups for analysis. Statistical analysis
was performed using IBM SPSS Statistics for Windows, version
24.0.
Results: The study included 64 male and 36 female patients,
with an average mean age of 55.90±16.51 years (range: 18-
86 years). Among the 100 patients, 21 died within the sevenday hospitalisation period. Among these, two were in the
hypoglycaemic group, 13 were in the normoglycaemic group,
and six were in the stress hyperglycaemic group. The patients
had a mean SOFA score of 11.55±2.20, which was significantly
higher compared to patients without organ failure (mean score:
2.54±2.55), with a statistically significant association (p<0.01).
Similarly, patients who died during hospitalisation had a very
high SOFA score (mean score: 9.76±3.36), also statistically
significant (p<0.01).
Conclusion: Critically ill patients in the stress hyperglycaemia and
hypoglycaemia groups during their ICU stay had a worse prognosis
compared to patients with normoglycaemia. Hypoglycaemia
during the ICU stay was associated with the poorest outcome.
Maintaining normoglycaemia can significantly reduce morbidity
and mortality in critically ill non-diabetic patients; therefore,
considering Continuous Glucose Monitoring Systems (CGMS)
for more frequent glycaemic monitoring and reducing glycaemic
variability may lead to better outcomes in the ICU. |
|---|---|
| ISSN: | 2249-782X 0973-709X |