Incidence and Predictors of Dysglycemia in Intensive Care Unit Patients: A Cohort Study.

Abstract

Many patients admitted to the intensive care unit (ICU) experience dysglycemia, i.e., hyperglycemia, hypoglycemia, and high glycemic variability, which are linked to poor outcomes. Early identification of patients at risk could potentially improve prevention and management. We aimed to report overall incidences of dysglycemia and investigate early identifiable predictors. This was a single-center prospective cohort study including 577 acutely admitted adult patients at the mixed medical and surgical ICU at Copenhagen University Hospital-North Zealand. Blood glucose was measured as point-of-care, dysglycemia was assessed for the first 5 days of admission, and predictors were identified on day one. For all patients, mean glucose was 9.1 mmol/L (SD ±2.2), median derived time spent in 3.9-10 mmol/L was 75% (47-93), and 47 of the 577 patients (8.2%) had a minimum of one episode of hypoglycemia ≤ 3.9 mmol/L. Nutritional therapy was associated with increased time in the target range, and high admission glucose, glucocorticoid treatment, and diabetes were associated with increased risk of hyperglycemia. Chronic kidney disease, acute kidney injury, diabetes, septic shock, increased sequential organ failure score, and surgical admission were all associated with increased risk of hypoglycemia. In this study of acutely admitted adult ICU patients, hypoglycemia was most common on the first day whereas hyperglycemia displayed smaller daily variations. Septic shock, CKD, AKI, diabetes, surgical admission, and a higher SOFA score were associated with an increased risk of hypoglycemia. Diabetes, high admission glucose, and glucocorticoid administration were associated with an increased risk of hyperglycemia. Increased focus on early identification of patients at risk of developing dysglycemia may improve glucose management. Hypoglycemia and hyperglycemia events are described in this single center critical care cohort, together with associated factors, and during the first days of intensive care unit stay. Insulin therapy was administered by widely-accepted ICU treatment guidelines in this cohort.