Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients

Abstract

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.

What is the optimal range of glycemic control for non‐diabetic patients undergoing gastroenterological surgery? A single‐center randomized controlled trial using an artificial pancreas

“…30 In vivo and clinical studies have revealed that glycemic variability has more detrimental effects than persistent hyperglycemia. [30][31][32] In contrast, our previous studies demonstrated that perioperative tight glycemic control using AP resulted in no hypoglycemia and less variability in blood concentrations. 12,13 We assessed the true impact of different glycemic control target ranges after reducing the effects of glucose variability and hypoglycemia using AP.…”

“…In addition, high glycemic variability reportedly results in higher oxidative stress production, increased inflammatory cytokines, and apoptosis induction in vascular endothelial cells 30 . In vivo and clinical studies have revealed that glycemic variability has more detrimental effects than persistent hyperglycemia 30–32 . In contrast, our previous studies demonstrated that perioperative tight glycemic control using AP resulted in no hypoglycemia and less variability in blood concentrations 12,13 .…”

“…This is a phase III, single-center, open-label, randomized control trial to determine the optimal range of perioperative glycemic control in non-diabetic patients undergoing gastroenterological surgery. The study was approved by the Institutional Review Board of Kochi Medical School Hospital (approval numbers [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and registered in the UMIN Clinical Trials Registry (ID: UMIN000028036). All the patients provided written informed consent to participate in the trial.…”

Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort

“…These observations suggest that the bene cial effects of steroids on mortality in COVID-19 seem to outweigh the harmful effects of steroids on glucose control in this cohort. Despite the aforementioned, maximum glucose difference is shown to be a strong determinant of worse outcome in previous studies in general critical care, regardless of pre-existing diabetes mellitus 31 . Since we observed an association between higher maximum glucose difference per day and higher mortality, independent of known risk factors, comorbidities, without effect-modi cation by wave and known or unknown diabetes mellitus, we provide evidence to focus supportive care on in order to ameliorate survival of critically ill COVID-19 patients.…”

The association between hemoglobin A1c and all-cause mortality in the ICU: A cross-section study based on MIMIC-IV 2.0

“…Furthermore, compared to COVID-19 patients with a diabetes diagnosis, critically ill and COVID-19 patients with HbA1c levels above 6.5% and no prior diagnosis of diabetes had the highest risk of all-cause mortality ( 17 ). Furthermore, there was a study reporting that critically ill patients with unknown diabetes had higher mortality and higher glycemic variability ( 18 ), which were reported to be independently associated with in-hospital mortality and 30-day mortality in the ICU ( 19 , 20 ). The relationship between HbA1c and long- or short-term outcomes following ICU discharge, on the other hand, has not been studied.…”