PURPOSE: Glycemic control in critically ill patients has been the subject of a major debate over the last decade,and the optimal glucose range remains unclear.While earlier studies done on surgical patients suggested that tight glucose control(TGC)[80-110 mg/dl] decreased mortality and morbidity,a recent large trial demonstrated worse outcome with increased incidence of hypoglycemia.This prompted review of the Surviving Sepsis Campaign(r)(SSC)recommendations in 2009 regarding TGC.Our study was designed to compare the outcomes of patients with severe sepsis/septic shock since implementation of intensive insulin therapy(IIT)at Cooper University Hospital,and to determine the incidence of hypoglycemia and any association with mortality.
METHODS: We performed a retrospective observational study of all patients admitted to a medical/surgical ICU from 3/1/2005 through 9/30/2009 with the diagnosis of severe sepsis or septic shock and entered into either the SSC(r) or the Project Impact(r) Database.Glucose readings were collected during the first 6-24 hrs of ICU admission.Hypoglycemia(HY) was defined as one or more readings < 70 mg/dl.Data was analyzed using Pearson Chi-square for proportions,and one-way ANOVA for means.
RESULTS: 706 patients were divided into 4 groups: I. BS 70-150 no HY(n= 420), II. One or more BS >150 (n=129), III. HY(n=137) , and IV. BS>150 and HY (n=20). The Age was 60.9[±16.7] (P=0.76 for all groups). The proportion of DM was 26 % in I, 50% in II, 39% in III and 70% in IV (P<.001). 89% of patients had APACHEII Scores recorded with means of 19.4, 20.1, 22.9 and 23.9 respectively (p<.001). 157 patients had at least one HY (22%). Mortality was lowest in I (27.4%) followed by II (30.4%), IV (35%) and III (42.3%) (P<.001). A comparison of I and II vs. III and IV showed significantly increased risk of mortality with HY (OR=1.76x[1.2x-2.55], P<.003).
CONCLUSION: Hypoglycemia is a frequent occurrence in septic patients and is associated with increased mortality.Patients with all BS 70-150 had the best outcomes.Further studies should be done to determine optimal glucose range in septic patients.
CLINICAL IMPLICATIONS: Practice of glycemic control in ICU.
DISCLOSURE: Moussa Yazbeck, No Financial Disclosure Information; No Product/Research Disclosure Information