Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients
Background. This retrospective study aimed to determine the correlation of blood glucose and glycemic variability with mortality and to identify the strongest glycemic variability parameter for predicting mortality in critically ill patients. Methods. A total of 528 patients admitted to the medical...
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Wiley
2020-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2020/5071509 |
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| author | Thanaphruet Issarawattana Rungsun Bhurayanontachai |
| author_facet | Thanaphruet Issarawattana Rungsun Bhurayanontachai |
| author_sort | Thanaphruet Issarawattana |
| collection | DOAJ |
| description | Background. This retrospective study aimed to determine the correlation of blood glucose and glycemic variability with mortality and to identify the strongest glycemic variability parameter for predicting mortality in critically ill patients. Methods. A total of 528 patients admitted to the medical intensive care unit were included in this study. Blood glucose levels during the first 24 hours of admission were recorded and calculated to determine the glycemic variability. Significant glycemic variability parameters, including the standard deviation, coefficient of variation, maximal blood glucose difference, and J-index, were subsequently compared between intensive care unit survivors and nonsurvivors. A binary logistic regression was performed to identify independent factors associated with mortality. To determine the strongest glycemic variability parameter to predict mortality, the area under the receiver operating characteristic of each glycemic variability parameter was determined, and a pairwise comparison was performed. Results. Among the 528 patients, 17.8% (96/528) were nonsurvivors. Both survivor and nonsurvivor groups were clinically comparable. However, nonsurvivors had significantly higher median APACHE-II scores (23 [21, 27] vs. 18 [14, 22]; p < 0.01) and a higher mechanical ventilator support rate (97.4% vs. 74.9%; p < 0.01). The mean blood glucose level and significant glycemic variability parameters were higher in nonsurvivors than in survivors. The maximal blood glucose difference yielded a similar power to the coefficient of variation (p = 0.21) but was significantly stronger than the standard deviation (p = 0.005) and J-index (p = 0.006). Conclusions. Glycemic variability was independently associated with intensive care unit mortality. Higher glycemic variability was identified in the nonsurvivor group regardless of preexisting diabetes mellitus. The maximal blood glucose difference and coefficient of variation of the blood glucose were the two strongest parameters for predicting intensive care unit mortality in this study. |
| format | Article |
| id | doaj-art-9e2a9829f9054554a5333a9568cc5d34 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
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| series | Critical Care Research and Practice |
| spelling | doaj-art-9e2a9829f9054554a5333a9568cc5d342025-02-03T05:49:54ZengWileyCritical Care Research and Practice2090-13052090-13132020-01-01202010.1155/2020/50715095071509Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU PatientsThanaphruet Issarawattana0Rungsun Bhurayanontachai1Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, ThailandCritical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, ThailandBackground. This retrospective study aimed to determine the correlation of blood glucose and glycemic variability with mortality and to identify the strongest glycemic variability parameter for predicting mortality in critically ill patients. Methods. A total of 528 patients admitted to the medical intensive care unit were included in this study. Blood glucose levels during the first 24 hours of admission were recorded and calculated to determine the glycemic variability. Significant glycemic variability parameters, including the standard deviation, coefficient of variation, maximal blood glucose difference, and J-index, were subsequently compared between intensive care unit survivors and nonsurvivors. A binary logistic regression was performed to identify independent factors associated with mortality. To determine the strongest glycemic variability parameter to predict mortality, the area under the receiver operating characteristic of each glycemic variability parameter was determined, and a pairwise comparison was performed. Results. Among the 528 patients, 17.8% (96/528) were nonsurvivors. Both survivor and nonsurvivor groups were clinically comparable. However, nonsurvivors had significantly higher median APACHE-II scores (23 [21, 27] vs. 18 [14, 22]; p < 0.01) and a higher mechanical ventilator support rate (97.4% vs. 74.9%; p < 0.01). The mean blood glucose level and significant glycemic variability parameters were higher in nonsurvivors than in survivors. The maximal blood glucose difference yielded a similar power to the coefficient of variation (p = 0.21) but was significantly stronger than the standard deviation (p = 0.005) and J-index (p = 0.006). Conclusions. Glycemic variability was independently associated with intensive care unit mortality. Higher glycemic variability was identified in the nonsurvivor group regardless of preexisting diabetes mellitus. The maximal blood glucose difference and coefficient of variation of the blood glucose were the two strongest parameters for predicting intensive care unit mortality in this study.http://dx.doi.org/10.1155/2020/5071509 |
| spellingShingle | Thanaphruet Issarawattana Rungsun Bhurayanontachai Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients Critical Care Research and Practice |
| title | Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients |
| title_full | Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients |
| title_fullStr | Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients |
| title_full_unstemmed | Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients |
| title_short | Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients |
| title_sort | maximal glycemic difference the possible strongest glycemic variability parameter to predict mortality in icu patients |
| url | http://dx.doi.org/10.1155/2020/5071509 |
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