Incidence and outcomes of early hyperglycaemia in critically ill patients
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Abstract
Background. Hyperglycaemia is common in hospitalised patients. Acute illness or injury may result in glucose intolerance and insulin resistance leading to hyperglycaemia. There is a lack of data on the incidence and impact of early hyperglycaemia in critically ill patients in South Africa (SA).
Objectives. To determine the incidence of hyperglycaemia within 48 hours of admission to a multidisciplinary SA ICU and to determine if there was any association between blood glucose level and ICU outcomes.
Methods. This was a retrospective observational study of patients admitted to ICU at King Edward VIII Hospital from November 2021 to August 2022. All blood glucose values were recorded within the first 48 hours of admission. The primary outcome was ICU mortality, with secondary outcomes including ICU length of stay (LOS), ventilator days (LOV), renal replacement therapy (RRT) and wound infection.
Results. A total of 177 patients were included in the study. Hyperglycaemia with a blood glucose of more than 10 mmol/L within 48 hours of ICU admission occurred more frequently in those who died in ICU (79.5%) v. ICU survivors (60.1%) (p=0.026). Hyperglycaemia was associated with an increase in ICU LOS, LOV and wound infection. No statistically significant relationship was found between hyperglycaemia and RRT. Hypoglycaemia within 48 hours of ICU admission was also associated with an increased ICU mortality.
Conclusion. Extremes of blood glucose were associated with increased ICU mortality. We recommend a moderate glycaemic control target of 6 - 10 mmol/L in resource-limited settings.
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References
1. Lipton JA, Barendse RJ, Van Domburg RT, et al. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high-risk cardiac patients admitted to an intensive cardiac care unit. Eur heart J Acute Cardiovasc Care 2013;2(4):306-313. https:// doi.org/10.1177/2048872613489304
2. Laird AM, Miller PR, Kilgo PD, Meredith JW, Chang MC. Relationship of early hyperglycemia to mortality in trauma patients. J Trauma 2004;56(5):1058-1062. https://doi.org/10.1097/01. TA.0000123267.39011.9F
3. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345(19):1359-1367. https://doi.org/10.1056/nejmoa011300
4. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354(5):449-461. https://doi.org/10.1056/NEJMoa052521
5. Nice-Sugar Study Investigators. Intensive v. conventional glucose control in critically ill patients. N Engl J Med 2009;360(13):1283-1297. https://doi.org/10.1056/NEJMoa0810625
6. Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358(2):125-139. https://doi.org/10.1056/NEJMoa070716
7. Krinsley JS, Preiser JC. Time in blood glucose range 70 to 140 mg/dL >80% is strongly
associated with increased survival in non-diabetic critically ill adults. Crit Care 2015;19(1):179.
https://doi.org/10.1186/s13054-015-0908-7
8. Omar AS, Salama A, Allam M, et al. Association of time in blood glucose range with outcomes following cardiac surgery. BMC Anesthesiol 2015;15(1):14. https://doi.org/10.1186/1471-2253- 15-14
9. Emidio AC, Faria R, Bispo B, Vaz-Pinto V, Messias A, Meneses-Oliveira C. GlucoSTRESS - A project to optimise glycemic control in a level C (III) Portuguese intensive care unit. Rev Bras Ter Intensiva 2021;33(1):138-145. https://doi.org/10.5935/0103-507X.20210015
10. Maharaj D, Perrie H, Scribante J, Paruk F. Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap. South Afr J Crit Care 2017;33(1):4-7. https:// doi.org/10.7196/SAJCC.2017.v33i1.280
11. ElhouniAA,deVasconcellosK.Theutilityofhyperlactataemiainthedefinitionofsepticshock: Evaluating the Sepsis-3 definitions in a sub-Saharan African intensive care unit. S Afr Med J 2019;109(11):880-884. https://doi.org/10.7196/samj.2019.v109i11.13968
12. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801-810. https://doi.org/10.1001/ jama.2016.0287
13. Jaganath UV, de Vasconcellos K, Skinner DL, Gopalan PD. An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa. South Afr J Crit Care 2023;39(2). https://doi.org/10.7196/SAJCC.2023.v39i2.867
14. Van Vught LA, Wiewel MA, Klein Klouwenberg PMC, et al. Admission hyperglycemia in critically ill sepsis patients: Association with outcome and host response. Critical Care Med 2016;44(7):1338-1346. https://doi.org/10.1097/CCM.0000000000001650
15. Christiansen C, Toft P, Jørgensen HS, Andersen SK, Tønnesen E. Hyperglycaemia and mortality in critically ill patients. Intensive Care Med 2004;30(8):1685-1688. https://doi.org/10.1007/ s00134-004-2325-2
16. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014;371(3):287-288. https://doi.org/10.1056/NEJMra1209390
17. Clain J, Ramar K, Surani SR. Glucose control in critical care. World J Diabetes 2015;6(9):1082- 1091. https://doi.org/10.4239/wjd.v6.i9.1082
18. Krinsley JS, Schultz MJ, Spronk PE, et al. Mild hypoglycemia is independently associated with increased mortality in the critically ill. Crit Care 2011;15(4):R173. https://doi.org/10.1186/ cc10322
19. Andersen A, Jørgensen PG, Knop FK, Vilsbøll T. Hypoglycaemia and cardiac arrhythmias in diabetes. Ther Adv Endocrinol Metabol 2020;11:1-11. https://doi. org/10.1177/2042018820911803
20. Callahan LA, Supinski GS. Hyperglycemia and acquired weakness in critically ill patients: Potential mechanisms. Crit Care 2009;13(2):125. https://doi.org/10.1186/cc7728