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Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes.

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  • 1eHealth Center, Westchester Medical Center Health Network, Valhalla, NY; Department of Medicine, New York Medical College, Valhalla; Division of Pulmonary, Critical Care and Sleep Medicine, New York Medical College, Valhalla; Department of Anesthesiology, Westchester Medical Center and New York Medical College, Valhalla.

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Achieving acceptable blood glucose control (<180 mg/dL) in the ICU reduces hospital mortality. Suboptimal glycemic control increases the risk of longer ICU and hospital stays for critically ill patients.

Keywords:
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Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Clinical Research

Background:

  • Glycemic control is crucial in medical intensive care units (ICUs).
  • Defining and assessing glycemic control categories (acceptable vs. suboptimal) is important for patient outcomes.
  • Previous studies have explored glucose management in critical care, but robust categorization and outcome comparison are needed.

Purpose of the Study:

  • To categorize glycemic control in a medical ICU as acceptable (<180 mg/dL) or suboptimal (>180 mg/dL) using time-weighted daily blood glucose averages.
  • To identify clinical risk factors associated with suboptimal glycemic control.
  • To compare clinical outcomes, including mortality and length of stay, between patients with acceptable and suboptimal glycemic control.

Main Methods:

  • Retrospective cohort study conducted in an academic tertiary and quaternary medical ICU.
  • Analysis of 920 complete data sets from 974 unit stays over a 2-year period.
  • Statistical analysis to identify risk factors and compare outcomes, adjusting for covariables and acuity.

Main Results:

  • 63% of patient stays had acceptable glycemic control, while 37% had suboptimal control.
  • Risk factors for suboptimal control included diabetes mellitus (OR 5.08), corticosteroid use (OR 4.50), and catecholamine infusions (OR 1.42).
  • Acceptable glycemic control was linked to decreased hospital mortality (OR 0.65), while suboptimal control increased odds of longer ICU (OR 1.76) and hospital stays (OR 1.50).

Conclusions:

  • Maintaining time-weighted average blood glucose levels below 180 mg/dL in the ICU significantly reduces hospital mortality in high-acuity medical patients.
  • Suboptimal glycemic control in the ICU is associated with increased odds of prolonged ICU and hospital stays.
  • These findings highlight the importance of optimizing glycemic control for improved outcomes in critically ill patients.