Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulinReport as inadecuate

Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 18:R86

First Online: 30 April 2014Received: 05 December 2013Accepted: 08 April 2014


IntroductionBoth patient- and context-specific factors may explain the conflicting evidence regarding glucose control in critically ill patients. Blood glucose variability appears to correlate with mortality, but this variability may be an indicator of disease severity, rather than an independent predictor of mortality. We assessed blood glucose coefficient of variation as an independent predictor of mortality in the critically ill.

MethodsWe used eProtocol-Insulin, an electronic protocol for managing intravenous insulin with explicit rules, high clinician compliance, and reproducibility. We studied critically ill patients from eight hospitals, excluding patients with diabetic ketoacidosis and patients supported with eProtocol-insulin for < 24 hours or with < 10 glucose measurements. Our primary clinical outcome was 30-day all-cause mortality. We performed multivariable logistic regression, with covariates of age, gender, glucose coefficient of variation standard deviation-mean, Charlson comorbidity score, acute physiology score, presence of diabetes, and occurrence of hypoglycemia < 60 mg-dL.

ResultsWe studied 6101 critically ill adults. Coefficient of variation was independently associated with 30-day mortality odds ratio 1.23 for every 10% increase, P < 0.001, even after adjustment for hypoglycemia, age, disease severity, and comorbidities. The association was higher in non-diabetics OR = 1.37, P < 0.001 than in diabetics OR 1.15, P = 0.001.

ConclusionsBlood glucose variability is associated with mortality and is independent of hypoglycemia, disease severity, and comorbidities. Future studies should evaluate blood glucose variability.

AbbreviationsICD-9International Statistical Classification of Diseases and Related Health Problems 9 revision


NICE-SUGARNormoglycaemia in intensive care evaluation and survival using glucose algorithm regulation

ORodds ratio.

Electronic supplementary materialThe online version of this article doi:10.1186-cc13851 contains supplementary material, which is available to authorized users.

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Author: Michael J Lanspa - Justin Dickerson - Alan H Morris - James F Orme - John Holmen - Eliotte L Hirshberg


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