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Cited by 285Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchIntensive Care Unit Cognitive Disorders

The Impact of Early Hypoglycemia and Blood Glucose Variability on Outcome in Critical Illness

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Bagshaw, Sean M, Bellomo, Rinaldo, Jacka, Michael J, Egi, Moritoki, Hart, Graeme K, George, Carol, the ANZICS CORE Management Committee·2009·Critical Care
DOI 10.1186/cc7921PMC PMC2717463
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Abstract

Introduction: In critical illness, the association of hypoglycemia, blood glucose (BG) variability and outcome are not well understood. We describe the incidence, clinical factors and outcomes associated with an early hypoglycemia and BG variability in critically ill patients. Methods: Retrospective interrogation of prospectively collected data from the Australia New Zealand Intensive Care Society Adult Patient Database on 66184 adult admissions to 24 intensive care units (ICUs) from 1 January 2000 to 31 December 2005. Primary exposure was hypoglycemia (BG < 4.5 mmol/L) and BG variability (BG < 4.5 and ≥ 12.0 mmol/L) within 24 hours of admission. Primary outcome was all-cause mortality. Results: The cumulative incidence of hypoglycemia and BG variability were 13.8% (95% confidence interval (CI) = 13.5 to 14.0; n = 9122) and 2.9% (95%CI = 2.8 to 3.0, n = 1913), respectively. Several clinical factors were associated with both hypoglycemia and BG variability including: co-morbid disease (P < 0.001), non-elective admissions (P < 0.001), higher illness severity (P < 0.001), and primary septic diagnosis (P < 0.001). Hypoglycemia was associated with greater odds of adjusted ICU (odds ratio (OR) = 1.41, 95% CI = 1.31 to 1.54) and hospital death (OR = 1.36, 95% CI = 1.27 to 1.46). Hypoglycemia severity was associated with 'dose-response' increases in mortality. BG variability was associated with greater odds of adjusted ICU (1.5, 95% CI = 1.4 to 1.6) and hospital (1.4, 95% CI = 1.3 to 1.5) mortality, when compared with either hypoglycemia only or neither. Conclusions: In critically ill patients, both early hypoglycemia and early variability in BG are relatively common, and independently portend an increased risk for mortality.

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  • The rate of hypoglycemia in the intensive care setting depends on the definition used, with incidence rates in the first 24 hours of admission ranging from 1.5% (blood glucose <44 mg/dL) to almost 14% (blood glucose <82 mg/dL).

    “The rate of hypoglycemia in the intensive care setting depends on the definition used, with incidence rates in the first 24 h of admission ranging from 1.5% (if hypoglycemia is defined as a blood glucose &lt; 44 mg/dL) to almost 14% (if hypoglycemia is defined as a blood glucose &lt; 82 mg/dL) [22].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [22]

    The Discussion (page unavailable) reports 13.8% with blood glucose below 4.5 mmol/L (about 81 mg/dL) in the first day of ICU admission, supporting the ‘almost 14%’ endpoint. It reports 1.4%, not 1.5%, below 2.5 mmol/L (about 45 mg/dL, rather than 44 mg/dL), so the lower endpoint does not match exactly. (LLM, conf=0.88)

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Authors
Bagshaw, S. M., Bellomo, R., Jacka, M. J., Egi, M., Hart, G. K., George, C., & the ANZICS CORE Management Committee
Affiliations
  • University of Alberta (CA)
  • The University of Melbourne (AU)
  • Okayama University Hospital (JP)
  • Australian and New Zealand Intensive Care Society (AU)
Corresponding author
Bellomo, Rinaldo
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2009-06-17
Volume
13
Issue
3
Pages
R91-R91
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/cc7921
PMC
PMC2717463
OpenAlex
W2077534740
Cited by
285
References
46
Citations by year
2026: 10 · 2025: 10 · 2024: 6 · 2023: 14 · 2022: 11 · 2021: 13 · 2020: 15 · 2019: 21 · 2018: 16 · 2017: 16 · 2016: 19 · 2015: 24 · 2014: 16 · 2013: 16 · 2012: 30
FWCI
18.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Funders
Fondation pour la Recherche Médicale
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
hypoglycemia, blood glucose variability, critical illness, ICU mortality, sepsis, comorbidities, non-elective admission, disease severity, critically ill adults
MeSH terms
Female, Humans, Hypoglycemia, Intensive Care Units, Male, Middle Aged, New Zealand, Prognosis, Retrospective Studies, Incidence, Multivariate Analysis, Logistic Models, Critical Illness, Hospital Mortality, Glucose Metabolism Disorders

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