Suboptimal glycaemic control prolongs ICU, hospital stay in critically ill patients

High-acuity medically critically ill patients who achieve time–weighted average daily blood glucose levels <180 mg/dL while in the intensive care unit (ICU) have a significantly lower likelihood of subsequent hospital mortality, a study has found.

In contrast, those with suboptimal glycaemic control during ICU stay have significantly higher odds of longer-than-predicted ICU and hospital stay.

This retrospective cohort study was conducted at an academic tertiary and quaternary medical ICU. The authors categorized glycaemic control as either acceptable or suboptimal based on time–weighted daily blood glucose averages of <180 mg/dL or >180 mg/dL. They also identified clinical risk factors for suboptimal control and compared outcomes between the two glycaemic control categories.

Of the 974 unit stays over a 2-year period, 920 had complete data sets available for analysis. Sixty-three percent of stays (n=575) were classified as having acceptable glycaemic control and 37 percent (n=345) as having suboptimal glycaemic control.

Patients with diabetes mellitus (odds ratio [OR], 5.08, 95 percent confidence interval [CI], 3.72–6.93), corticosteroid use during ICU stay (OR, 4.50, 95 percent CI, 3.21–6.32), and catecholamine infusions (OR, 1.42, 95 percent CI, 1.04–1.93) had the highest likelihood of suboptimal glycaemic control after adjusting for covariables.

Adjusting for acuity, acceptable glycaemic control resulted in decreased odds of hospital mortality (OR, 0.65, 95 percent CI, 0.48–0.88) but not ICU mortality (OR, 0.81, 95 percent CI, 0.55–1.17). Suboptimal glycaemic control correlated with increased odds of longer-than-predicted ICU (OR, 1.76, 95 percent CI, 1.30–2.38) and hospital stays (OR, 1.50, 95 percent CI, 1.12–2.01).