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|Title:||Glycemic lability index and mortality in critically ill patients - a multicenter cohort study.||Austin Authors:||Hanna, Michel;Balintescu, Anca;Glassford, Neil;Lipcsey, Miklos;Eastwood, Glenn M ;Oldner, Anders;Bellomo, Rinaldo ;Mårtensson, Johan||Affiliation:||Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden..
Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden..
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden..
Hedenstierna Laboratory, Department of Surgical Sciences, Section of Anaesthesiology and Intensive care, Uppsala University, Uppsala, Sweden..
|Issue Date:||8-May-2021||metadata.dc.date:||2021-05-08||Publication information:||Acta Anaesthesiologica Scandinavica 2021; online first: 8 May||Abstract:||Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship. In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available pre-admission glycated hemoglobin A1c (HbA1c) and ≥3 glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs below cohort median) and TWA-BG (above vs below cohort median) with hospital mortality. Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/l]2 /h/week, median TWA-BG was 8.2 mmol/l, 171 (7%) developed hypoglycemia, and 371 (16%) died. The adjusted odds ratio for death was 1.61 (95% CI, 1.19-2.15; P=0.002) for GLI above vs. below median and 1.06 (95% CI, 0.80-1.41; P=0.67) for TWA-BG above vs. below median. The relationship between GLI and mortality was not modified by TWA-BG (P [interaction]=0.66), a history of diabetes (P [interaction]=0.89) or by HbA1c ≥52 mmol/mol (vs. <52 mmol/mol) (P [interaction]=0.29). In adult patients admitted to ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.||URI:||https://ahro.austin.org.au/austinjspui/handle/1/26410||DOI:||10.1111/aas.13843||ORCID:||0000-0002-1976-4129
|PubMed URL:||33964015||Type:||Journal Article||Subjects:||Critical care
|Appears in Collections:||Journal articles|
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