Admission hyperglycemia and other risk factors as predictors of hospital mortality in a medical ICU population

Amado Freire, Lisa Bridges, Guillermo E. Umpierrez, David Kuhl, Abbas E. Kitabchi

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Abstract

Background: Tight glycemic control is recommended for patients in the ICU, as hyperglycemia is associated with increased morbidity and mortality. Design: Observational cohort of patients admitted to a 12-bed, inner-city, medical ICU (MICU). Subjects: A total of 1,185 of 1,506 patients from July 1, 1999, to December 31, 2002, selected based on a diagnosis other than diabetic ketoacidosis or glycemia > 280 mg/dL or < 80 mg/dL. Purpose: To determine if the highest serum glucose level within 24 h after ICU admission is associated with increased hospital mortality when adjusted for confounders. Measurements: Age, gender, race, worst values within 24 h after ICU admission to construct the acute physiology and chronic health evaluation (APACHE) II score, and highest glucose within 24 h after ICU admission. Hospital mortality was the primary outcome. Admitting diagnosis, MICU length of stay (LOS), and hospital LOS were obtained. Glucose, albumin (n = 867), and lactic acid (n = 319) were stratified for analysis. Analysis: Univariate analysis identified factors included in the multivariate model. Results: Patients were predominantly African-American (79%) and men (56%; mean age, 49.2 years). The mean ICU admission highest glucose level was 139 ± 43.7 mg/dL (± SD). MICU LOS and hospital LOS were 6.2 days and 12.9 days, respectively, and 50% of patients received mechanical ventilation. MICU and hospital mortality were 18% and 20%, respectively; standardized mortality ratio was 66%. On univariate analysis, survivors (n = 945) and nonsurvivors (n = 240) showed APACHE II score, mechanical ventilation, hypoalbuminemia, lactic acidemia, and logistic organ dysfunction system score to be hospital mortality predictors; however, the highest admission serum glucose level was not. Logistic regression estimated APACHE II score/per point (odds ratio, 1.06; 95% confidence interval, 1.02 to 1.11), mechanical ventilation (odds ratio, 3.06; 95% confidence interval, 1.34 to 6.96), severe hypoalbuminemia (< 2 g/dL) [odds ratio, 2.98; 95% confidence interval, 1.3 to 7.02], and severe lactic acidemia (≥ 8 mmol/L) [odds ratio, 7.3; 95% confidence interval, 2.14 to 24.9], but not ICU admission hyperglycemia, to be associated with hospital mortality. Conclusions: Conventional factors of disease severity, but not highest glucose value during the first 24 h after ICU admission, predict hospital mortality in an inner-city MICU.

Original languageEnglish (US)
Pages (from-to)3109-3116
Number of pages8
JournalChest
Volume128
Issue number5
DOIs
StatePublished - Jan 1 2005

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Hospital Mortality
Hyperglycemia
Length of Stay
Glucose
APACHE
Odds Ratio
Artificial Respiration
Confidence Intervals
Population
Hypoalbuminemia
Milk
Organ Dysfunction Scores
Diabetic Ketoacidosis
Mortality
Serum
African Americans
Statistical Factor Analysis
Survivors
Albumins
Lactic Acid

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Admission hyperglycemia and other risk factors as predictors of hospital mortality in a medical ICU population. / Freire, Amado; Bridges, Lisa; Umpierrez, Guillermo E.; Kuhl, David; Kitabchi, Abbas E.

In: Chest, Vol. 128, No. 5, 01.01.2005, p. 3109-3116.

Research output: Contribution to journalArticle

Freire, Amado ; Bridges, Lisa ; Umpierrez, Guillermo E. ; Kuhl, David ; Kitabchi, Abbas E. / Admission hyperglycemia and other risk factors as predictors of hospital mortality in a medical ICU population. In: Chest. 2005 ; Vol. 128, No. 5. pp. 3109-3116.
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abstract = "Background: Tight glycemic control is recommended for patients in the ICU, as hyperglycemia is associated with increased morbidity and mortality. Design: Observational cohort of patients admitted to a 12-bed, inner-city, medical ICU (MICU). Subjects: A total of 1,185 of 1,506 patients from July 1, 1999, to December 31, 2002, selected based on a diagnosis other than diabetic ketoacidosis or glycemia > 280 mg/dL or < 80 mg/dL. Purpose: To determine if the highest serum glucose level within 24 h after ICU admission is associated with increased hospital mortality when adjusted for confounders. Measurements: Age, gender, race, worst values within 24 h after ICU admission to construct the acute physiology and chronic health evaluation (APACHE) II score, and highest glucose within 24 h after ICU admission. Hospital mortality was the primary outcome. Admitting diagnosis, MICU length of stay (LOS), and hospital LOS were obtained. Glucose, albumin (n = 867), and lactic acid (n = 319) were stratified for analysis. Analysis: Univariate analysis identified factors included in the multivariate model. Results: Patients were predominantly African-American (79{\%}) and men (56{\%}; mean age, 49.2 years). The mean ICU admission highest glucose level was 139 ± 43.7 mg/dL (± SD). MICU LOS and hospital LOS were 6.2 days and 12.9 days, respectively, and 50{\%} of patients received mechanical ventilation. MICU and hospital mortality were 18{\%} and 20{\%}, respectively; standardized mortality ratio was 66{\%}. On univariate analysis, survivors (n = 945) and nonsurvivors (n = 240) showed APACHE II score, mechanical ventilation, hypoalbuminemia, lactic acidemia, and logistic organ dysfunction system score to be hospital mortality predictors; however, the highest admission serum glucose level was not. Logistic regression estimated APACHE II score/per point (odds ratio, 1.06; 95{\%} confidence interval, 1.02 to 1.11), mechanical ventilation (odds ratio, 3.06; 95{\%} confidence interval, 1.34 to 6.96), severe hypoalbuminemia (< 2 g/dL) [odds ratio, 2.98; 95{\%} confidence interval, 1.3 to 7.02], and severe lactic acidemia (≥ 8 mmol/L) [odds ratio, 7.3; 95{\%} confidence interval, 2.14 to 24.9], but not ICU admission hyperglycemia, to be associated with hospital mortality. Conclusions: Conventional factors of disease severity, but not highest glucose value during the first 24 h after ICU admission, predict hospital mortality in an inner-city MICU.",
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AU - Bridges, Lisa

AU - Umpierrez, Guillermo E.

AU - Kuhl, David

AU - Kitabchi, Abbas E.

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N2 - Background: Tight glycemic control is recommended for patients in the ICU, as hyperglycemia is associated with increased morbidity and mortality. Design: Observational cohort of patients admitted to a 12-bed, inner-city, medical ICU (MICU). Subjects: A total of 1,185 of 1,506 patients from July 1, 1999, to December 31, 2002, selected based on a diagnosis other than diabetic ketoacidosis or glycemia > 280 mg/dL or < 80 mg/dL. Purpose: To determine if the highest serum glucose level within 24 h after ICU admission is associated with increased hospital mortality when adjusted for confounders. Measurements: Age, gender, race, worst values within 24 h after ICU admission to construct the acute physiology and chronic health evaluation (APACHE) II score, and highest glucose within 24 h after ICU admission. Hospital mortality was the primary outcome. Admitting diagnosis, MICU length of stay (LOS), and hospital LOS were obtained. Glucose, albumin (n = 867), and lactic acid (n = 319) were stratified for analysis. Analysis: Univariate analysis identified factors included in the multivariate model. Results: Patients were predominantly African-American (79%) and men (56%; mean age, 49.2 years). The mean ICU admission highest glucose level was 139 ± 43.7 mg/dL (± SD). MICU LOS and hospital LOS were 6.2 days and 12.9 days, respectively, and 50% of patients received mechanical ventilation. MICU and hospital mortality were 18% and 20%, respectively; standardized mortality ratio was 66%. On univariate analysis, survivors (n = 945) and nonsurvivors (n = 240) showed APACHE II score, mechanical ventilation, hypoalbuminemia, lactic acidemia, and logistic organ dysfunction system score to be hospital mortality predictors; however, the highest admission serum glucose level was not. Logistic regression estimated APACHE II score/per point (odds ratio, 1.06; 95% confidence interval, 1.02 to 1.11), mechanical ventilation (odds ratio, 3.06; 95% confidence interval, 1.34 to 6.96), severe hypoalbuminemia (< 2 g/dL) [odds ratio, 2.98; 95% confidence interval, 1.3 to 7.02], and severe lactic acidemia (≥ 8 mmol/L) [odds ratio, 7.3; 95% confidence interval, 2.14 to 24.9], but not ICU admission hyperglycemia, to be associated with hospital mortality. Conclusions: Conventional factors of disease severity, but not highest glucose value during the first 24 h after ICU admission, predict hospital mortality in an inner-city MICU.

AB - Background: Tight glycemic control is recommended for patients in the ICU, as hyperglycemia is associated with increased morbidity and mortality. Design: Observational cohort of patients admitted to a 12-bed, inner-city, medical ICU (MICU). Subjects: A total of 1,185 of 1,506 patients from July 1, 1999, to December 31, 2002, selected based on a diagnosis other than diabetic ketoacidosis or glycemia > 280 mg/dL or < 80 mg/dL. Purpose: To determine if the highest serum glucose level within 24 h after ICU admission is associated with increased hospital mortality when adjusted for confounders. Measurements: Age, gender, race, worst values within 24 h after ICU admission to construct the acute physiology and chronic health evaluation (APACHE) II score, and highest glucose within 24 h after ICU admission. Hospital mortality was the primary outcome. Admitting diagnosis, MICU length of stay (LOS), and hospital LOS were obtained. Glucose, albumin (n = 867), and lactic acid (n = 319) were stratified for analysis. Analysis: Univariate analysis identified factors included in the multivariate model. Results: Patients were predominantly African-American (79%) and men (56%; mean age, 49.2 years). The mean ICU admission highest glucose level was 139 ± 43.7 mg/dL (± SD). MICU LOS and hospital LOS were 6.2 days and 12.9 days, respectively, and 50% of patients received mechanical ventilation. MICU and hospital mortality were 18% and 20%, respectively; standardized mortality ratio was 66%. On univariate analysis, survivors (n = 945) and nonsurvivors (n = 240) showed APACHE II score, mechanical ventilation, hypoalbuminemia, lactic acidemia, and logistic organ dysfunction system score to be hospital mortality predictors; however, the highest admission serum glucose level was not. Logistic regression estimated APACHE II score/per point (odds ratio, 1.06; 95% confidence interval, 1.02 to 1.11), mechanical ventilation (odds ratio, 3.06; 95% confidence interval, 1.34 to 6.96), severe hypoalbuminemia (< 2 g/dL) [odds ratio, 2.98; 95% confidence interval, 1.3 to 7.02], and severe lactic acidemia (≥ 8 mmol/L) [odds ratio, 7.3; 95% confidence interval, 2.14 to 24.9], but not ICU admission hyperglycemia, to be associated with hospital mortality. Conclusions: Conventional factors of disease severity, but not highest glucose value during the first 24 h after ICU admission, predict hospital mortality in an inner-city MICU.

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