Hypoglycemia and hospital mortality in critically ill patients

Prior research has indicated that adopting strict glycemic control measures might elevate the risk of hypoglycemia and result in higher mortality rates among critically ill patients. However, there is a lack of studies investigating the incidence of hypoglycemia and its consequential outcomes in real-world clinical settings. This retrospective cohort study was conducted at Taichung Veterans General Hospital, utilizing critical care databases covering the period from 2015 to 2020. The objective was to examine the outcomes and identify risk factors associated with hypoglycemia in critically ill patients. Out of the total of 16,699 patients admitted to the intensive care units (ICUs), 2,115(12.7%) experienced at least one episode of hypoglycemia were included in the analysis. Critically ill patients who developed hypoglycemia had a significantly higher hospital mortality rate compared to those who did not experience hypoglycemia. (48.9% vs. 15.9%, p < 0.001). Moreover, patients with more severe hypoglycemia exhibited a higher mortality rate (moderate hypoglycemia: hazard ratio [HR] 1.477, 95% confidence interval [C.I.] 1.351-1.614, p < 0.001; severe hypoglycemia: HR 1.847, 95% C.I. 1.607-2.123, p < 0.001) compared to those without hypoglycemia. Additionally, patients with greater frequency of hypoglycemic episodes also showed a higher mortality rate (one episode HR 1.504, 95% C.I. 1.366-1.657, p < 0.001; multiple episodes HR 1.613, 95% C.I. 1.444-1.801, p < 0.001) compared to those without hypoglycemia. Patient who experienced spontaneous hypoglycemia (53.9% vs. 42.4%, p < 0.001) and those without a prior diagnosis of diabetes (60.2% vs. 37.0%, p < 0.001) had higher mortality rate. Hypoglycemia frequently occurs and serves as an independent risk factor for mortality among critically ill individuals, particularly in cases of severe and recurrent episodes. Patients experiencing spontaneous hypoglycemia, as well as those lacking a diabetes diagnosis, demonstrated elevated mortality rates.