Hyperglycaemia in critically ill patients: marker or mediator of mortality?

Abstract

Acute hyperglycaemia has been associated with complications, prolonged intensive care unit and hospital stay, and increased mortality. We made an inventory of the prevalence and prognostic value of hyperglycaemia, and of the effects of glucose control in different groups of critically ill patients. The prevalence of hyperglycaemia in critically ill patients, using stringent criteria, approaches 100%. An unambiguous negative correlation between hyperglycaemia and mortality has been described in various groups of critically ill patients. Although the available evidence remains inconsistent, there appears to be a favourable effect of glucose regulation. This effect on morbidity and mortality depends on patient characteristics. To be able to compare results of future studies involving glucose regulation, better definitions of hyperglycaemia (and consequently of normoglycaemia) and patient populations are needed.

Figure 1

Survival by blood glucose level. Shown are Kaplan-Meier survival curves for patients without known diabetes mellitus and admission blood glucose levels less than 141 mg/dl (7.8 mmol/l; group 1), 141–199 mg/dl (7.8–11.0 mmol/l; group 2) and 200.0 mg/dl (11.1 mmol/l) or higher (group 3), and patients with previously diagnosed with diabetes (group 4). Adapted from Stranders and coworkers [16].

Figure 2

Relationship between mean blood glucose during ICU stay and ICU mortality. Blood glucose levels are given in mmol/l. Data are from 1085 consecutive mixed ICU patients [4]. ICU, intensive care unit.