Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis
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OBJECTIVES: Hyperglycemia during critical illness is common and is associated with increased mortality. Intensive insulin therapy has improved outcomes in some, but not all, intervention trials. It is unclear whether the benefits of treatment differ among specific patient populations. The purpose of the study was to determine the association between hyperglycemia and risk- adjusted mortality in critically ill patients and in separate groups stratified by admission diagnosis. A secondary purpose was to determine whether mortality risk from hyperglycemia varies with intensive care unit type, length of stay, or diagnosed diabetes. DESIGN: Retrospective cohort study. SETTING: One hundred seventy-three U.S. medical, surgical, and cardiac intensive care units. PATIENTS: Two hundred fifty-nine thousand and forty admissions from October 2002 to September 2005; unadjusted mortality rate, 11.2%. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A two-level logistic regression model determined the relationship between glycemia and mortality. Age, diagnosis, comorbidities, and laboratory variables were used to calculate a predicted mortality rate, which was then analyzed with mean glucose to determine the association of hyperglycemia with hospital mortality. Hyperglycemia was associated with increased mortality independent of illness severity. Compared with normoglycemic individuals (70-110 mg/dL), adjusted odds of mortality (odds ratio, [95% confidence interval]) for mean glucose 111-145, 146-199, 200-300, and >300 mg/dL was 1.31 (1.26-1.36), 1.82 (1.74-1.90), 2.13 (2.03-2.25), and 2.85 (2.58-3.14), respectively. Furthermore, the adjusted odds of mortality related to hyperglycemia varied with admission diagnosis, demonstrating a clear association in some patients (acute myocardial infarction, arrhythmia, unstable angina, pulmonary embolism) and little or no association in others. Hyperglycemia was associated with increased mortality independent of intensive care unit type, length of stay, and diabetes. CONCLUSIONS: The association between hyperglycemia and mortality implicates hyperglycemia as a potentially harmful and correctable abnormality in critically ill patients. The finding that hyperglycemia-related risk varied with admission diagnosis suggests differences in the interaction between specific medical conditions and injury from hyperglycemia. The design and interpretation of future trials should consider the primary disease states of patients and the balance of medical conditions in the intensive care unit studied.
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Therapeutic strategies can reduce glucose swings and prevent hypoglycemia.
“Therapeutic approaches can minimize glycemic excursions and prevent hypoglycemia.1243–1247”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1244]
The Introduction (page not provided) reports that intensive insulin therapy normalized blood glucose in one ICU trial, lending some support to the idea that treatment can control glucose. It does not say therapeutic approaches minimize glucose swings or prevent hypoglycemia; instead, it notes that excessive hypoglycemia led to early cessation of some trials. (LLM, conf=0.82)
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- Authors
- Falciglia, M., Freyberg, R. W., Almenoff, P. L., D’Alessio, D. A., & Render, M. L.
- Affiliations
- University of Cincinnati (US)
- Cincinnati VA Medical Center (US)
- The University of Kansas Health System (US)
- Venue
- Critical Care Medicine
- Published
- 2009-12
- Volume
- 37
- Issue
- 12
- Pages
- 3001-3009
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC2905804
- OpenAlex
- W2025416505
- Cited by
- 576
- References
- 70
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 24 · 2023: 32 · 2022: 37 · 2021: 33 · 2020: 33 · 2019: 35 · 2018: 32 · 2017: 42 · 2016: 43 · 2015: 50 · 2014: 50 · 2013: 28 · 2012: 28
- FWCI
- 22.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Institute of Diabetes and Digestive and Kidney Diseases (DK K23 74440, DK R01 57900, R01DK057900, K23DK074440)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- critically ill patients, mortality, admission diagnosis, intensive care unit, length of hospital stay, diabetes mellitus, acute myocardial infarction, cardiac arrhythmias, unstable angina, pulmonary embolism, risk-adjusted mortality, glycemia, intensive insulin therapy, disease severity, trauma, sepsis, respiratory failure, renal failure, liver failure
- MeSH terms
- Adult, Aged, Female, Humans, Hyperglycemia, Male, Middle Aged, Patient Admission, Retrospective Studies, Risk Factors, Cohort Studies, Critical Illness
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