The association of glucose control on in-hospital mortality in the cardiac intensive care unit

ElsevierVolume 37, Issue 4, April 2023, 108453Journal of Diabetes and its ComplicationsAuthor links open overlay panel, , , , AbstractBackground

Current guidelines recommend maintaining serum blood glucose (BG) levels between 150 and 180 mg/dL for patients admitted to the intensive care unit (ICU); however, these recommendations are based on randomized controlled trials among general ICU patients and observational studies among specific subgroups. Little is known about the impact of glucose control among patients cared for in the cardiac intensive care unit (CICU).

Methods

This was a retrospective cohort analysis of patients >18 years of age admitted to the University of Michigan CICU from December 2016 through December 2020 with at least one BG measurement during CICU admission. The primary outcome was in-hospital mortality. The secondary outcome was CICU length of stay.

Results

A total of 3217 patients were included. When analyzed based on quartiles of mean CICU BG, there were significant differences in in-hospital mortality across BG quartiles for those with diabetes mellitus (DM) and those without DM. In multivariable logistic regression, age, Elixhauser comorbidity score, use of mechanical ventilation, any hypoglycemic event, and any BG value >180 mg/dL were significant predictors for in-hospital mortality in both patients with and without DM, yet average BG was only predictive of in-hospital mortality in patients without DM.

Conclusions

This study highlights the importance of glucose control in critically ill adult patients admitted to the CICU. The trends in mortality based on quartiles and deciles of average BG suggest a difference in optimal blood glucose levels in those with and without DM. However, regardless of diabetes status, mortality increases with higher average BG.

Section snippetsBackground

Hyperglycemia in the intensive care unit (ICU) is common, even among non-diabetics, and may be due to a number of factors including the release of stress hormones, use of exogenous glucocorticoids and catecholamines, and release of mediators in sepsis.1 The Society of Critical Care Medicine recommends maintaining serum glucose levels between 150 and 180 mg/dL in medical and surgical ICU patients.2 These recommendations are based on randomized controlled trials (RCT) among general ICU patient

Study design and patient selection

This was a retrospective cohort analysis of patients >18 years of age admitted to the University of Michigan CICU between December 2016 and December 2020. Glucose management decisions in the CICU were made on an individual basis by the clinical team caring for the patient. The study was approved by the University of Michigan Institutional Review Board. Informed consent was waived given the retrospective nature of this work.

Outcomes

The primary outcome was in-hospital mortality. The secondary outcome was

Baseline demographics

A total of 3217 patients were admitted to the University of Michigan CICU from December 2016 to December 2020 with at least one BG measurement. Baseline demographics are summarized in Table 1. Baseline demographics for blood glucose quartiles (BGQ) of patients in the DM and non-DM cohorts are found in Table 2, Table 3, respectively. The mean age was 63.3 ± 15 years though patients in the cohort with DM were significantly older than those patients without DM (65.2 ± 12.5 vs 61.9 ± 16.5; p

Discussion

This study highlights the importance of glucose control in critically ill adult patients admitted to the CICU. The trends in mortality based on quartiles of average blood glucose suggest a difference in optimal BG levels in those with and without DM. However, regardless of DM status, mortality increases with higher average BG and hypoglycemic events should be avoided.

The association between hyperglycemia and clinical outcomes in various ICU populations has been demonstrated in numerous

Conclusions

In this retrospective cohort of 3217 patients admitted to the CICU, after adjustment for other factors, hyperglycemia was associated with increased mortality. A U-shaped curve for impact of BG on mortality was seen in patients with DM that was not evident in those without DM. The highest mortality in patients with and without DM was seen in the highest quartile of average blood glucose. Given differences in mortality trends by BGQs in our study between patients with and without DM, future

CRediT authorship contribution statement

Sarah K. Adie: conceptualization, data curation, methodology, manuscript preparation Scott W. Ketcham: conceptualization, methodology, manuscript reviewing and editing Vincent D. Marshall: analyze and synthesize study data Nicholas Farina: conceptualization, methodology, manuscript reviewing and editing Devraj Sukul: conceptualization, methodology, manuscript reviewing and editing.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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