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Published on: June 11, 2012
Glucose control and mortality in critically ill patients
Simon J Finney1, Cornelia Zekveld, Andi Elia
1Adult Intensive Care Unit, Royal Brompton Hospital, London, England.
JAMA
|October 16, 2003
Summary
In critically ill patients, higher insulin doses correlate with increased mortality, irrespective of blood glucose levels. Effective glycemic control, not just insulin quantity, is key to reducing deaths in the intensive care unit (ICU).
Area of Science:
- Critical Care Medicine
- Endocrinology
- Metabolic Disorders
Background:
- Hyperglycemia is prevalent in critically ill patients, including those without diabetes.
- Aggressive glycemic control may decrease mortality in this patient group.
- The precise relationship between mortality, hyperglycemia control, and insulin administration remains unclear.
Purpose of the Study:
- To investigate the association between blood glucose levels and insulin administration with mortality in critically ill patients.
- To determine if glycemic control or insulin quantity is more critical for reducing mortality.
Main Methods:
- A single-center, prospective, observational study involving 531 adult patients admitted to an intensive care unit (ICU) in the UK.
- Primary endpoint: ICU mortality. Secondary endpoints: hospital mortality, ICU and hospital length of stay, and predicted glucose thresholds for mortality risk.
- Multivariable logistic regression analysis was used to assess the relationship between insulin administration, glucose levels, and mortality.
Main Results:
- ICU and hospital mortality rates were 5.2% and 5.7%, respectively.
- Increased insulin administration was significantly associated with higher ICU mortality (OR, 1.02 per 1-IU/d increase at 111-144 mg/dL glucose).
- Mortality benefits were observed below a predicted glucose threshold of 144-200 mg/dL, suggesting benefits from glycemic control.
Conclusions:
- Increased insulin administration is positively associated with ICU mortality, independent of prevailing blood glucose levels.
- The mortality benefit observed in intensive insulin therapy likely stems from effective glucose control rather than the absolute amount of insulin administered.
- Targeting glucose control, potentially below 145 mg/dL, may be more crucial than solely focusing on insulin dosage.
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