Glucometrics in the first week of critical illness and its association with mortality / Glucometría en la primera semana de enfermedad crítica y su asociación con la mortalidad

Objective Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. Design Prospective observational study. Setting Mixed ICU of teaching hospital. Patients Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. Main variables of interest Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. Results A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162–178.75), SD 31mg/dL (26–38.75), CV 18.6% (17.1–22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5–1131.5) and TIR 57% (50–67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). Conclusions Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections (AU)

Objetivo Evaluación de la glucometría en la primera semana de estancia en la UCI y su asociación con los resultados. Diseño Estudio observacional prospectivo. Ámbito UCI mixta de hospital docente. Pacientes Adultos que iniciaron una infusión de insulina para dos lecturas consecutivas de glucosa en sangre (GS) ≥180mg/dl. Principales variables de interés Glucometría calculada a partir de la GS de la primera semana de ingreso: episodios de hiperglucemia (GS >180mg/dl) e hipoglucemia (GS <70mg/dl); mediana, desviación estándar (DE) y coeficiente de variación (CV) de GS, índice de labilidad glucémica (ILG), tiempo en el rango objetivo de GS (TIR). Resultados Se incluyeron un total de 5.762 GS en 100 pacientes con una mediana de edad de 55años. Glucometría: hiperglucemia: 2.253 (39%), hipoglucemia: 28 (0,48%), mediana GS: 169mg/dl, DE 31mg/dl, CV 18,6%, ILG: 718,5 [(mg/dl)2/h]/semana, TIR 57%. La diabetes y una puntuación APACHEII más alta se asociaron con una DE y un CV más altos y una TIR más baja. En la regresión multivariada, la diabetes (p=0,009) y la puntuación APACHEII (p=0,016) se asociaron de forma independiente con una DE más alta. La DE y el CV más altos se asociaron con menos días sin vasopresores; menor TIR, con más infecciones del torrente sanguíneo (ITS). En el análisis multivariado, el ILG solo se asoció con una mayor mortalidad (OR: 2,99, p=0,04). Conclusiones La labilidad glucémica en la primera semana en pacientes de UCI que reciben infusión de insulina se asocia con mayor mortalidad. Una TIR más baja se asocia con más ITS (AU)

Association of the time in targeted blood glucose range of 3.9-10 mmol/L with the mortality of critically ill patients with or without diabetes.

Purpose: The relationship between the TIR and mortality may be influenced by the presence of diabetes and other glycemic indicators. The purpose of this study was to investigate the relationship between TIR and in-hospital mortality in diabetic and non-diabetic patients in ICU. Methods: A total of 998 patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9-10.0 mmol/L within 24 h. The relationship between TIR and in-hospital mortality in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. Results: The binary logistic regression model showed that there was a significant association between the TIR and the in-hospital death of severely ill non-diabetic patients. Furthermore, TIR≥70% was significantly associated with in-hospital death (OR = 0.581, P = 0.003). The study found that the coefficient of variation (CV) was significantly associated with the mortality of severely ill diabetic patients (OR = 1.042, P = 0.027). Conclusions: Both diabetic and non-diabetic critically ill patients should control blood glucose fluctuations and maintain blood glucose levels within the target range, it may be beneficial in reducing mortality.

Glucometrics in the first week of critical illness and its association with mortality.

OBJECTIVE: Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. DESIGN: Prospective observational study. SETTING: Mixed ICU of teaching hospital. PATIENTS: Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. MAIN VARIABLES OF INTEREST: Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. RESULTS: A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162-178.75), SD 31mg/dL (26-38.75), CV 18.6% (17.1-22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5-1131.5) and TIR 57% (50-67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). CONCLUSIONS: Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections.

Meta-analysis of effects of different target blood glucose control on postoperative complications during fasting after abdominal surgery / 中国实用护理杂志

Objective To investigate the effects of different target blood glucose control on postoperative complications during fasting after abdominal surgery by Meta-analysis. Methods From January 1990 to May 2016 the computer retrieval of related Chinese and foreign literature into surgery during the fasting blood glucose control in different range of patients, were randomly divided into control group and intervention group, from two independent data extraction and document evaluation. Meta-analysis using RevMan5.3 software. Results A total of 6 articles were included. Meta-analysis results showed that after abdominal surgery during the fasting of different target blood glucose control on the incidence of hypoglycemia, the incidence of postoperative complications of surgical incision infection after operation, the differences were statistically significant (P<0.05), However, there was no significant difference in postoperative mortality rate (P>0.05). Conclusions After abdominal surgery in patients with intensive glycemic control during the fasting ,value at the lower range (4.4-6.1mmol/L) can effectively reduce the incision infection and the incidence of postoperative complications, is conducive to the rehabilitation of patients, but increase the risk of hypoglycemia, and it has little effect on the mortality of patients during hospitalization. The control group included blood glucose range is too large or lack of continuity and included in the study Chinese literature is too small, leads to a limitation of the research, the analysis results still need more clinical nursing practice and a large number of high quality documents to support.