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Early blood glucose control and mortality in critically ill patients in Australia*

Bagshaw, Sean M. MD, MSc; Egi, Moritoki MD; George, Carol MBus (IT), BSc; Bellomo, Rinaldo MD for the ANZICS Database Management Committee

doi: 10.1097/CCM.0b013e318194b097
Clinical Investigations
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Objective: To measure temporal trends in blood glucose (BG) control and describe their association with hospital mortality in a cohort of critically ill patients from Australia.

Design: Interrogation of prospectively collected data from the Australia New Zealand Intensive Care Society Adult Patient Database.

Setting: Twenty-four intensive care units (ICU) across Australia.

Patients and Participants: A cohort of 66,184 adult ICU admissions for ≥24 hours from January 1, 2000, to December 31, 2005.

Interventions: None.

Measurements and Main Results: Highest and lowest BG values within 24 hours of ICU admission, standard demographic, clinical, and physiologic data, and hospital mortality. Medical, mechanically ventilated surgical, cardiac surgical, and septic subgroups were evaluated. Average BG was evaluated as a continuous variable and by quartiles (low [<5.6 mmol/L], near normal [5.6–8.69 mmol/L], high [8.69–11.79 mmol/L], and highest [>11.79 mmol/L]). There were 132,368 BG values, with a mean (95% confidence intervals) value 8.69 mmol/L (8.66–8.73). There was no trend in BG for the entire cohort (p = 0.66) over the study period; yet, BG increased after 2002 (0.17 mmol/L, p < 0.0001). The mechanically ventilated surgical and cardiac surgical subgroups had decreasing trends in BG (p < 0.001), whereas the septic subgroup had an increasing BG trend (p < 0.001). BG in the low, high, and highest quartiles, compared with the near-normal quartile, were consistently associated with higher hospital mortality in crude (odds ratio 1.31, 1.58, and 2.00) and multivariable analysis (odds ratio 1.29, 1.07, and 1.10), respectively. This association was similarly shown for the mechanically ventilated surgical and cardiac surgical subgroups.

Conclusions: In a large cohort of ICU patients from Australia, there was no significant change in early glycemic control from 2000 to 2005. There were differences in selected subgroups. Average BG decreased in surgical subgroups, whereas it increased in septic patients. Both high and early low BG values were independently associated with hospital mortality.

From the Division of Critical Care Medicine (SMB), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada; Department of Intensive Care (SMB, RB), Austin Hospital, Melbourne, Australia; Department of Anesthesiology and Resuscitology (ME), Okayama University Hospital, Okayama, Japan; Australia New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) (CG), Melbourne, Australia; and Department of Medicine (RB), Melbourne University, Melbourne, Australia.

Supported, in part, by the Austin Hospital Anaesthesia and Intensive Care Trust Fund.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: bagshaw@ualberta.ca

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins