Citation Information :
Hamishehkar H, Iranpour A, Beigmohammadi M. Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients. Indian J Crit Care Med 2016; 20 (2):67-71.
Background and Aims: The association between hyperglycemia and mortality is believed to be influenced by the presence of diabetes mellitus (DM). In this study, we evaluated the effect of preexisting hyperglycemia on the association between acute blood glucose management and mortality in critically ill patients. The primary objective of the study was the relationship between HbA1c and mortality in critically ill patients. Secondary objectives of the study were relationship between Intensive Care Unit (ICU) admission blood glucose and glucose control during ICU stay with mortality in critically ill patients.
Materials and Methods: Five hundred patients admitted to two ICUs were enrolled. Blood sugar and hemoglobin A1c (HbA1c) concentrations on ICU admission were measured. Age, sex, history of DM, comorbidities, Acute Physiology and Chronic Health Evaluation II score, sequential organ failure assessment score, hypoglycemic episodes, drug history, mortality, and development of acute kidney injury and liver failure were noted for all patients.
Results: Without considering the history of diabetes, nonsurvivors had significantly higher HbA1c values compared to survivors (7.25 ± 1.87 vs. 6.05 ± 1.22, respectively, P < 0.001). Blood glucose levels in ICU admission showed a significant correlation with risk of death (P < 0.006, confidence interval [CI]: 1.004–1.02, relative risk [RR]: 1.01). Logistic regression analysis revealed that HbA1c increased the risk of death; with each increase in HbA1c level, the risk of death doubled. However, this relationship was not statistically significant (P: 0.161, CI: 0.933–1.58, RR: 1.2).
Conclusions: Acute hyperglycemia significantly affects mortality in the critically ill patients; this relation is also influenced by chronic hyperglycemia.
Li L, Messina JL. Acute insulin resistance following injury. Trends Endocrinol Metab 2009;20:429-35.
Thorell A, Nygren J, Ljungqvist O. Insulin resistance: A marker of surgical stress. Curr Opin Clin Nutr Metab Care 1999;2:69-78.
Negargar S, Mahmoodpoor A, Taheri R, Sanaie S. The relationship between cerebral oxygen saturation changes and post operative neurologic complications in patients undergoing cardiac surgery. Pak J Med Sci 2007;23:380-5.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008;34:17-60.
Collier B, Diaz J Jr., Forbes R, Morris J Jr., May A, Guy J, et al. The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit. JPEN J Parenter Enteral Nutr 2005;29:353-8.
Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004;79:992-1000.
Parish M, Mahmoodpoor A, Sanaie S. Validity of fasting blood sugar on the day of surgery compared with the preinduction blood glucose level in type II diabetic patients. Pak J Med Sci 2007;23:202-5.
Mahmoodpoor A, Ali-Asgharzadeh A, Parish M, Amir-Aslanzadeh Z, Abedini N. A comparative study of efficacy of intensive insulin therapy versus conventional method on mortality and morbidity of critically ill patients. Pak J Med Sci 2011;27:496-9.
Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab 2010;95:4338-44.
Falciglia M, Freyberg RW, Almenoff PL, D'Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 2009;37:3001-9.
Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: Six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg 2006;18:317-25.
Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, et al. The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes. Crit Care Med 2011;39:105-11.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011;34 Suppl 1:S62-9.
Gornik I, Gornik O, Gasparovic V. HbA1c is outcome predictor in diabetic patients with sepsis. Diabetes Res Clin Pract 2007;77:120-5.
Takao T, Matsuyama Y, Yanagisawa H, Kikuchi M, Kawazu S. Association between HbA1c variability and mortality in patients with type 2 diabetes. J Diabetes Complications 2014;28:494-9.
Paprott R, Schaffrath Rosario A, Busch MA, Du Y, Thiele S, Scheidt-Nave C, et al. Association between hemoglobin A1c and all-cause mortality: Results of the mortality follow-up of the German National Health Interview and Examination Survey 1998. Diabetes Care 2015;38:249-56.
Britton KA, Aggarwal V, Chen AY, Alexander KP, Amsterdam E, Fraulo E, et al. No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction. Am Heart J 2011;161:657-63.e1.
Finney SJ, Zekveld C, Elia A, Evans TW. Glucose control and mortality in critically ill patients. JAMA 2003;290:2041-7.
Zhang HY, Wu CJ, Li CS. Glycated hemoglobin A1C and diabetes mellitus in critically ill patients. World J Emerg Med 2013;4:201-4.
Plummer MP, Bellomo R, Cousins CE, Annink CE, Sundararajan K, Reddi BA, et al. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive Care Med 2014;40:973-80.
Rady MY, Johnson DJ, Patel BM, Larson JS, Helmers RA. Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus. Mayo Clin Proc 2005;80:1558-67.
Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Hegarty C, et al. Blood glucose concentration and outcome of critical illness: The impact of diabetes. Crit Care Med 2008;36:2249-55.
Krinsley JS, Egi M, Kiss A, Devendra AN, Schuetz P, Maurer PM, et al. Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: An international multicenter cohort study. Crit Care 2013;17:R37.
Kosiborod M, Inzucchi SE, Krumholz HM, Xiao L, Jones PG, Fiske S, et al. Glucometrics in patients hospitalized with acute myocardial infarction: Defining the optimal outcomes-based measure of risk. Circulation 2008;117:1018-27.
Stegenga ME, Vincent JL, Vail GM, Xie J, Haney DJ, Williams MD, et al. Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis. Crit Care Med 2010;38:539-45.
Zaghla HE, Elbadry MA, Ashour AM, Abdelfatah MM. Influence of admission blood glucose and hemoglobin A1c on outcome of acute myocardial infarction. Egypt J Intern Med 2014;26:21-6.
ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-72.
Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr., Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2545-59.
Farrugia DP, Sciberras S, Sant F, Abela CJ, Adami JZ, LaFerla G. Glycosylated haemoglobin (HbA1c) and cortisol levels on admission to intensive care as predictors of outcome. Malta Med J 2009;21:34-9.
Lionel KR, John J, Sen N. Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit. Indian J Crit Care Med 2014;18:21-5.
Viana MV, Moraes RB, Fabbrin AR, Santos MF, Torman VB, Vieira SR, et al. Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients: A prospective cohort study. BMC Endocr Disord 2014;14:50.
Kompoti M, Michalia M, Salma V, Diogou E, Lakoumenta A, Clouva-Molyvdas PM. Glycated hemoglobin at admission in the intensive care unit: Clinical implications and prognostic relevance. J Crit Care 2015;30:150-5.
Groop PH, Forsblom C, Thomas MC. Mechanisms of disease: Pathway-selective insulin resistance and microvascular complications of diabetes. Nat Clin Pract Endocrinol Metab 2005;1:100-10.
The Diabetes Control and Complications Trial Research Group. Early worsening of diabetic retinopathy in the diabetes control and complications trial. Arch Ophthalmol 1998;116:874-86.