Hypoglycemia is associated with intensive care unit mortality

OBJECTIVE: The implementation of intensiveinsulin therapy in the intensive care unitis accompanied by an increase in hypoglycemia. We studied the relation between hypoglycemiaon intensive care unitmortality, because the evidence on this subject is conflicting. DESIGN: Retrospective database cohort study. SETTING: An 18-bed medical/surgical intensive care unitin a teaching hospital (Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands). PATIENTS: A total of 5961 patients admitted to from 2004 to 2007 were analyzed. Readmissions and patients with a withholding care policy or with hypoglycemiaon the first glucose measurement were excluded. Patients were treated with a computerized insulin algorithm (target glucose range, 72-126 mg/dL). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All first episodes of hypoglycemia(glucose intensive care unitdeath and incidence rate ratiocomparing exposure and nonexposure to hypoglycemiawere calculated. Patients were considered to be exposed to hypoglycemiafrom the event until the end of intensive care unitadmittance. We corrected for severity of disease using the daily Sequential Organ Failure Assessmentscore. Age, sex, cardiothoracic surgery, sepsis, and diabetes mellitus were also included as possible confounders. Two hundred eighty-eight (4.8%) patients experienced at least one episode of hypoglycemia. Median age was 68 yrs (range, 58-75 yrs), 66% were male, and 6.4% died in the intensive care unit. The incidence rate of death in patients exposed to hypoglycemiawas 40 per 1000 intensive care unitdays compared with 17 per 1000 intensive care unitdays in patients without exposure. The adjusted incidence rate ratiofor intensive care unitdeath was 2.1 (95% confidence interval, 1.6-2.8; p <.001). CONCLUSIONS: Hypoglycemiais related to intensive care unitmortality, also when adjusted for a daily adjudicated measure of disease severity, indicating the possibility of a causal relationship