Early glycaemic variability increases 28-day mortality and prolongs intensive care unit stay in critically ill patients with pneumonia. (31st December 2022)

• Record Type: Journal Article
• Authors: Kim, Seong Ho; Kim, Ji Young; Kim, Eun Song; Park, Il Rae; Ha, Eun Yeong; Chung, Seung Min; Moon, Jun Sung; Yoon, Ji Sung; Won, Kyu Chang; Lee, Hyoung Woo
• Is Part Of: Annals of medicine. Volume 54:Number 1(2022)
• Page Start: 2736
• Page End: 2743
• Publication Date: 2022-12-31
• Subjects: Diabetes -- glycaemic variability -- coefficient of variation -- intensive care unit -- pneumonia; Medicine -- Periodicals; 610
• DOI: 10.1080/07853890.2022.2128399
• Languages: English
• ISSNs: 0785-3890

Abstract

Abstract: Objective: This study aimed to evaluate the effect of early glycaemic variability (GV) on 28-day mortality in critically ill patients with pneumonia. Patients and methods: This single-centre retrospective study included patients admitted to the intensive care unit (ICU) due to pneumonia between 2018 and 2019. A total of 282 patients (mean age, 68.6 years) with blood sugar test (BST) results measured more than three times within 48 h after hospitalization and haemoglobin A1c (HbA1c) levels recorded within 2 months were enrolled. Coefficient of variation (CV) was calculated using the BST values. The effects of GV on 28-day mortality and prolonged ICU stay (>14 days) were also assessed. Results: The mean age was 60.6 years (male to female ratio, 2.5:1). The 28-day mortality rate was 31.6% ( n = 89) and was not different according to the presence of diabetes (DM vs. non-DM) or HbA1c levels (≥7.5 vs. <7.5%; both p > .05). However, the mortality rate was significantly higher in patients with high GV (CV ≥ 36%) than in those with low GV (CV < 36%; 37.5 vs. 25.4%, p = .028). The risk of mortality in patients with high GV was prominent in the subgroups with DM or low HbA1c levels. Among the surviving patients ( n = 193), 44 remained in the ICU for more than 14 days. Compared to low GV, high GV was associated with a higher rate of prolonged ICU stay, although not statistically significant (27.8 vs . 18.5%, p = .171). After adjusting for the severity of illness and treatment strategy, CV was an independent risk factor for 28-day mortality (hazard ratio [HR], 1.01, p = .04) and prolonged ICU stay (odds ratio, 1.02; p = .04). Conclusions: High GV within 48 h of ICU admission was associated with an increased 28-day mortality risk and prolonged ICU stay. Early phase GV should be carefully managed in critically ill patients with pneumonia. KEY MESSAGES: The presence of diabetes or HbA1c alone is insufficient to predict 28-day mortality and prolonged ICU stay in critically ill patients with pneumonia. High glycaemic variability (GV) within 48 h of ICU admission increases 28-day mortality and prolongs ICU stay, which is consistent after adjusting for severity of illness and treatment strategy. Patients with high GV, especially those with DM or low HbA1c levels (<7.5%) should be more carefully treated to reduce mortality.