Iatrogenic hypoglycemia secondary to tight glucose control is an independent determinant for mortality and cardiac morbidity

Giuseppe D'Ancona, Federico Bertuzzi, Lucia Sacchi, Francesco Pirone, Vincenzo Stringi, Antonio Arcadipane, Riccardo Bellazzi, Michele Pilato

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Evaluation of the effects of tight glycemia control in critically ill patients should include temporal as well as punctual glycemia data. Methods: Insulin drip was used to target intensive care unit (ICU) glucose levels between 80 and 126mgdl -1 in a consecutive series of adult cardiac surgery patients. ICU hourly glycemia was prospectively recorded. Glycemia standard deviation, hyperglycemia index (area under the curve for glycemia>126mgdl -1 divided by total hours in ICU), and hypoglycemic episodes were recorded and analyzed, together with outcomes. Results: A total of 596 patients were included. Hypoglycemia occurred in 21% of the patients. In-hospital mortality was 2.6%. There was a univariate correlation between mortality and glycemia standard deviation, and hypoglycemia occurrence. At multivariate analysis, hypoglycemia was a determinant for mortality (p=0.002; odds ratio (OR)=20.0), respiratory failure (p=0.0001; OR=1.4), requirement of a tracheostomy (p=0.0001; OR=21.6), and hemodynamic instability requiring intra-aortic balloon pump (IABP) (p=0.01; OR=1.5). To clarify the determinants of hypoglycemia, a second multivariate model was built. Diabetes (p=0.0001; OR=23) and chronic renal failure (p=0.01; OR=25) were the sole determinants for hypoglycemia occurrence. Conclusion: Iatrogenic hypoglycemia secondary to ICU tight glycemia control correlates with hospital mortality, respiratory, and cardiac morbidity in patients undergoing cardiac surgery. ICU hyperglycemia index and glycemia temporal variability have no independent correlation with outcomes. Higher glycemia targets should be advised in the perioperative management of patients with diabetes and renal failure, as both conditions independently increase the risk of hypoglycemia occurrence.

Original languageEnglish
Pages (from-to)360-366
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume40
Issue number2
DOIs
Publication statusPublished - Aug 2011

Keywords

  • Cardiac surgery
  • Hypoglycemia
  • Morbidity
  • Mortality
  • Tight glucose control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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