Glycaemic Variability and Its Outcome in Intensive Care Unit Patients with Sepsis

Sepsis causes an uncontrollable activation of pro- and anti-inflammatory responses, leading to metabolic derangements, notably glucose variability (GV). Both hyperglycaemia and hypoglycaemia can occur in septic patients, regardless of the diabetes status. Hyperglycaemia control using insulin has been shown to reduce morbidity and mortality. Current guidelines suggest maintaining glucose levels between 140 and 180 mg/dL for better clinical outcomes. Managing glycaemic variability is crucial in reducing mortality in intensive care unit (ICU) patients with sepsis.

The study included patients aged ≥ 18 years, admitted for ≥ 24 h, focussing on the first 5 days of ICU stay. Data on patient characteristics, glucose values, comorbidities, organ failures, and outcomes were collected. GV was assessed, and comorbidities were determined using diagnostic codes.

Among a group of 100 patients (mean age 54.16 ± 18.5 years; 66% male), diabetes mellitus (84%) and hypertension (57%) were the most common comorbidities. Pneumonia (25%) and urosepsis (22%) were the primary sources of sepsis. Patients with multiple organ dysfunction syndrome (MODS) had significantly higher mean glucose levels (MGLs) than those without (P < 0.05). Higher glucose levels were also observed in non-survivors compared to survivors (P < 0.05). Glycaemic variability, measured by the coefficient of variation, was significantly higher in non-survivors. Insulin requirements were higher in unresolved cases (P < 0.05).

Higher glycaemic variability and MGLs were associated with increased mortality and MODS in ICU patients with sepsis. Improved outcomes were observed in patients with lower glycaemic variability, highlighting the need for insulin protocols to maintain optimal glucose control and reduce variability in critical care settings.