Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients.

Abstract

OBJECTIVE: To investigate the relationship between hyperglycemia and hospital mortality in a heterogeneous group of critically ill patients. PATIENTS AND METHODS: Retrospective data were reviewed for 1826 consecutive patients whose glucose values were obtained during their intensive care unit stay at The Stamford Hospital in Stamford, Conn, between October 1, 1999, and April 4, 2002. RESULTS: Mean and maximum glucose values were significantly higher among nonsurvivors than among survivors for the entire group (P < .001) and for each subgroup except for patients with septic shock. The lowest hospital mortality, 9.6%, occurred among patients with mean glucose values between 80 and 99 mg/dL. Hospital mortality increased progressively as glucose values increased, reaching 42.5% among patients with mean glucose values exceeding 300 mg/dL. Within each of 3 groupings of Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (0-14; 15-24; > or = 25), mean and maximum glucose values were higher among nonsurvivors than among survivors. CONCLUSION: Even a modest degree of hyperglycemia occurring after intensive care unit admission was associated with a substantial increase in hospital mortality in patients with a wide range of medical and surgical diagnoses. Analysis of glucose values added predictive power above that achieved by APACHE II scores alone. These results have important implications for the glycemic management of critically ill patients.