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. 2020 Feb 7;10(1):17.
doi: 10.1186/s13613-020-0635-3.

Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis

Wen-Cheng Chao  1   2 , Chien-Hua Tseng  3   4 , Chieh-Liang Wu  1   5   6 , Sou-Jen Shih  7 , Chi-Yuan Yi  7 , Ming-Cheng Chan  8   9   10   11
Affiliations

Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis

Wen-Cheng Chao et al. Ann Intensive Care. .

Abstract

Background: High glycemic variability (GV) is common in critically ill patients; however, the prevalence and mortality association with early GV in patients with sepsis remains unclear.

Methods: This retrospective cohort study was conducted in a medical intensive care unit (ICU) in central Taiwan. Patients in the ICU with sepsis between January 2014 and December 2015 were included for analysis. All of these patients received protocol-based management, including blood sugar monitoring every 2 h for the first 24 h of ICU admission. Mean amplitude of glycemic excursions (MAGE) and coefficient of variation (CoV) were used to assess GV.

Results: A total of 452 patients (mean age 71.4 ± 14.7 years; 76.7% men) were enrolled for analysis. They were divided into high GV (43.4%, 196/452) and low GV (56.6%, 256/512) groups using MAGE 65 mg/dL as the cut-off point. Patients with high GV tended to have higher HbA1c (6.7 ± 1.8% vs. 5.9 ± 0.9%, p < 0.01) and were more likely to have diabetes mellitus (DM) (50.0% vs. 23.4%, p < 0.01) compared with those in the low GV group. Kaplan-Meier analysis showed that a high GV was associated with increased 30-day mortality (log-rank test, p = 0.018). The association remained strong in the non-DM (log-rank test, p = 0.035), but not in the DM (log-rank test, p = 0.254) group. Multivariate Cox proportional hazard regression analysis identified that high APACHE II score (adjusted hazard ratio (aHR) 1.045, 95% confidence interval (CI) 1.013-1.078), high serum lactate level at 0 h (aHR 1.009, 95% CI 1.003-1.014), having chronic airway disease (aHR 0.478, 95% CI 0.302-0.756), high mean day 1 glucose (aHR 1.008, 95% CI 1.000-1.016), and high MAGE (aHR 1.607, 95% CI 1.008-2.563) were independently associated with increased 30-day mortality. The association with 30-day mortality remained consistent when using CoV to assess GV.

Conclusions: We found that approximately 40% of the septic patients had a high early GV, defined as MAGE > 65 mg/dL. Higher GV within 24 h of ICU admission was independently associated with increased 30-day mortality. These findings highlight the need to monitor GV in septic patients early during an ICU admission.

Keywords: Glycemic control; Glycemic variability; Sepsis.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there are no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment
Fig. 2
Fig. 2
Kaplan–Meier survival curves categorized by glycemic variability. Low GV, MAGE ≤ 65; high GV, MAGE > 65
Fig. 3
Fig. 3
Kaplan–Meier survival curves categorized by glycemic status in patients without (a) and with (b) DM. Low GV, MAGE ≤ 65; high GV, MAGE > 65
Fig. 4
Fig. 4
Individual glycemic variability (a, MAGE; b, CoV) in septic patients without and with DM. (C) Kaplan–Meier survival curves categorized by DM. **p < 0.005
Fig. 5
Fig. 5
Correlations among the two indicators for glycemic variability. MAGE mean amplitude of glycemic excursions, CoV coefficient of variation
See this image and copyright information in PMC

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