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Comparative Study
. 2009 Sep;127(5):259-65.
doi: 10.1590/s1516-31802009000500003.

Accuracy of different methods for blood glucose measurement in critically ill patients

Sérgio Antônio Pulzi Júnior  1 , Murillo Santucci Cesar de Assunção, Bruno Franco Mazza, Haggéas da Silveira Fernandes, Mirian Jackiu, Flávio Geraldo Resende Freitas, Flávia Ribeiro Machado
Affiliations
Comparative Study

Accuracy of different methods for blood glucose measurement in critically ill patients

Sérgio Antônio Pulzi Júnior et al. Sao Paulo Med J. 2009 Sep.

Abstract
in English, Portuguese

Context and objective: Although glucometers have not been validated for intensive care units, they are regularly used. The aim of this study was to compare and assess the accuracy and clinical agreement of arterial glucose concentration obtained using colorimetry (Agluc-lab), capillary (Cgluc-strip) and arterial (Agluc-strip) glucose concentration obtained using glucometry and central venous glucose concentration obtained using colorimetry (Vgluc-lab).

Design and setting: Cross-sectional study in a university hospital.

Method: Forty patients with septic shock and stable individuals without infection were included. The correlations between measurements were assessed both in the full sample and in subgroups using noradrenalin and presenting signs of tissue hypoperfusion.

Results: Cgluc-strip showed the poorest correlation (r = 0.8289) and agreement (-9.87 +/- 31.76). It exceeded the limits of acceptable variation of the Clinical and Laboratory Standards Institute in 23.7% of the cases, and was higher than Agluc-lab in 90% of the measurements. Agluc-strip showed the best correlation (r = 0.9406), with agreement of -6.75 +/- 19.07 and significant variation in 7.9%. For Vgluc-lab, r = 0.8549, with agreement of -4.20 +/- 28.37 and significant variation in 15.7%. Significant variation was more frequent in patients on noradrenalin (36.4% versus 6.3%; P = 0.03) but not in the subgroup with hypoperfusion. There was discordance regarding clinical management in 25%, 22% and 15% of the cases for Cgluc-strip, Vgluc-lab and Agluc-strip, respectively.

Conclusion: Cgluc-strip should be avoided, particularly if noradrenalin is being used. This method usually overestimates the true glucose levels and gives rise to management errors.

Clinical trial registration: ACTRN12608000513314 (registered as an observational, cross-sectional study).

CONTEXTO E OBJETIVO:: Apesar de glicosímetros não serem validados para unidades de terapia intensiva (UTI), seu uso é corriqueiro. O objetivo foi avaliar a acurácia e concordância clínica entre a glicemia arterial por colorimetria (glicA-lab), glicemias capilar (glicC-fita) e arterial (glicA-fita) por glicosimetria, e venosa central por colorimetria (glicV-lab).

TIPO DE ESTUDO E LOCAL:: Estudo transversal realizado em hospital universitário.

MÉTODO:: Foram incluídos 40 pacientes com choque séptico e indivíduos estáveis, sem infecção. A correlação entre medidas foi avaliada tanto na amostra global quanto nos subgrupos em uso de noradrenalina e com sinais de hipoperfusão tecidual.

RESULTADOS:: A glicC-fita mostrou pior correlação (r = 0,8289) e concordância (-9,87 ± 31,76). Esta superou os limites aceitáveis de variação do Clinical and Laboratory Standards Institute em 23,7% dos casos, sendo maior que a glicA-lab em 90% das vezes. A glicA-fita teve a melhor correlação (r = 0,9406), com concordância de -6,75 ± 19,07 e variação significativa em 7,9%. Para a glicV-lab, obteve-se r = 0,8549, concordância de -4,20 ± 28,37 e variação significativa em 15,7%. Variação significativa foi mais frequente em pacientes com noradrenalina (36,4% versus 6,3%, P = 0,03), mas não nos com hipoperfusão. Houve discordância de conduta clínica em 25%, 22,5% e 15% dos casos para glicC-fita, glicV-lab e glicA-fita, respectivamente.

CONCLUSÃO:: O uso de glicC-fita deveria ser evitado, principalmente se há uso de noradrenalina. Geralmente, este método superestima a glicemia real e acarreta erros de conduta.

REGISTRO DO ENSAIO CLÍNICO:: ACTRN12608000513314 (registrado como estudo observacional transversal)

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1.
Figure 1.. Pearson’s coefficient (1-A) and Bland and Altman’s test (1-B) between capillary blood glucose levels measured by glucometry (Cgluc-strip) and arterial blood glucose levels measured by colorimetry (Agluc-lab). Figure 1-A: r = 0.8289. Figure 1-B: bias = -9.87 ± 31.76 (-72.12 to +52.37). Full sample (n = 40). Blood glucose in mg/dl.
Figure 2.
Figure 2.. Pearson’s coefficient (2-A) and Bland and Altman’s test (2-B) between arterial blood glucose levels measured by glucometry (Agluc-strip) and arterial blood glucose levels measured by colorimetry (Agluc-lab). Figure 2-A: r = 0.9400. Figure 2-B: bias = -6.75 ± 19.07 (-44.13 to +30.63). Full sample (n = 40). Blood glucose in mg/dl.
Figure 3.
Figure 3.. Pearson’s coefficient (3-A) and Bland and Altman’s test (3-B) between central venous blood glucose levels measured by colorimetry (Vgluc-lab) and arterial blood glucose levels measured by colorimetry (Agluc-lab). Figure 3-A: r = 0.8549. Figure 3-B: bias = -4.20 ± 28.37 (-59.81 to +51.41). Full sample (n = 40). Blood glucose in mg/dl.
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