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Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury*

Dowdy, David W. ScM; Dinglas, Victoriano BS; Mendez-Tellez, Pedro A. MD; Bienvenu, O Joseph MD, PhD; Sevransky, Jonathan MD; Dennison, Cheryl R. PhD; Shanholtz, Carl MD; Needham, Dale M. MD, PhD

doi: 10.1097/CCM.0b013e31818781f5
Feature Articles

Objective: To evaluate the association between intensive care unit blood glucose levels and depression after acute lung injury.

Design: Prospective cohort study.

Setting: Twelve intensive care units in four hospitals in Baltimore, MD.

Patients: Consecutive acute lung injury survivors (n = 104) monitored during 1717 intensive care unit patient-days and screened for depression at 3 months after acute lung injury.

Interventions: None.

Measurements and Main Results: The prevalence of a positive screening test for depression (Hospital Anxiety and Depression subscale score ≥8) at follow-up was 28%. After adjustment for confounders, patients with a mean daily minimum intensive care unit glucose level <100 mg/dL had significant increases in mean depression score (2.1 points, 95% confidence interval 0.6–3.7) and in the likelihood of a positive depression screening test (relative risk 2.6, 95% confidence interval 1.2–4.2). Patients with documented hypoglycemia <60 mg/dL during their intensive care unit stay also had greater symptoms of depression (2.0 points, 95% confidence interval 0.5–3.5; relative risk 3.6, 95% confidence interval 1.8–5.1). Other factors independently associated with a positive depression screening test included body mass index >40 kg/m2 (relative risk 3.3, 95% confidence interval 1.2–4.2), baseline depression/anxiety (relative risk 3.9, 95% confidence interval 1.5–6.5), and mean daily intensive care unit benzodiazepine dose >100 mg of midazolam-equivalent agent (relative risk 2.4, 95% confidence interval 1.1–3.8).

Conclusions: Hypoglycemia in the intensive care unit is associated with an increased risk of positive screening for depression during early recovery from acute lung injury. Baseline depressive symptoms, morbid obesity, and intensive care unit benzodiazepine dose were also associated with postacute lung injury depressive symptoms. These findings warrant increased glucose monitoring for intensive care unit patients at risk for hypoglycemia and further research on how patient and intensive care unit management factors may contribute to postintensive care unit depression.

From the Department of Epidemiology (DWD), Johns Hopkins Bloomberg School of Public Health; School of Medicine (DWD), Division of Pulmonary/Critical Care Medicine (VD, JS, DMN), Departments of Anesthesiology/Critical Care Medicine (PAM-T), and Psychiatry and Behavioral Sciences (OJB), Johns Hopkins University; Johns Hopkins School of Nursing (CRD); and Division of Pulmonary/Critical Care Medicine, University of Maryland (CS), Baltimore, MD.

Supported in part by the National Institutes of Health (Acute Lung Injury SCCOR Grant no. P050 HL 73994). Mr. Dowdy is supported by the National Institutes of Health, Medical Scientist Training Program Award (T32 GMO7309). Drs. Dennison, Bienvenu, and Sevransky are supported by Mentored Patient-Oriented Research Career Development Awards from the National Institutes of Health (K23 NR009193, K23 MH64543, and K23 GM071399, respectively). Dr. Needham is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research.

The funding bodies had no role in the study design, manuscript writing, or decision to submit the manuscript for publication.

The authors have not disclosed any potential conflicts of interest.

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© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins