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Time in blood glucose range 70 to 180 mg/dL and survival rate in critically ill patients: A retrospective cohort study. | LitMetric

AI Article Synopsis

  • The study investigates the relationship between time in targeted blood glucose range (TIR) of 70-180 mg/dL and 28-day mortality among critically ill patients in an ICU setting.
  • Researchers analyzed data from over 1,200 ICU patients to determine if lower TIR levels were linked to higher mortality, particularly focusing on patients with different levels of glycosylated hemoglobin (HbA1c).
  • Results showed that for patients with HbA1c levels below 6.5%, having a TIR below 80% significantly increased the risk of death within 28 days, while no consistent association was found in patients with HbA1c of 6.5% or higher.

Article Abstract

Background: While time in targeted blood glucose range (TIR) 70-140 mg/dL is a known factor associated with mortality in critically ill patients, it remains unclear whether TIR is associated with 28-day mortality under the glycemic control with a less tight target glucose range of 70-180 mg/dL. We aimed to examine whether TIR 70-180 mg/dL was associated with 28-day mortality.

Methods: This is a retrospective cohort study using data from a tertiary care center in Japan collected from January 2016 through October 2019. We included adult patients (aged ≥20 years) admitted to the ICU. We excluded patients 1) with diabetic ketoacidosis patients, 2) discharged within 48 hours, 3) with repeated ICU admissions. We calculated TIR 70-180 mg/dL using the measured blood glucose values (≥3 times per day). The primary outcome was 28-day mortality. We examined the association between TIR and 28-day mortality using a logistic regression and Cox proportional hazard models with a stratification by glycosylated hemoglobin (HbA1c) level of 6.5%. Additionally, we repeated the analyses using the TIR category to assess the optimal TIR. For the sensitivity analysis, we repeated the primary analysis using TIR during the first three days from ICU admission.

Results: Of 1,230 patients, the median age was 72 years, 65% were male, and 250 patients (20%) had HbA1c ≥6.5% on admission. In patients with HbA1c <6.5%, TIR <80% was associated with an increased risk of 28-day mortality, with an adjusted odds ratio (OR) of 1.88 (95%CI: 1.36-2.61). Likewise, when using 10% incremental TIR as a categorical variable, lower TIR was associated with a worse 28-day mortality compared with TIR ≥90% (e.g., adjusted OR of TIR <60%, 3.62 [95%CI 2.36-5.53]). Similar associations were found in the analyses using Cox proportional hazards model and using TIR during the first three days. By contrast, in patients with HbA1c ≥6.5%, there was no consistent association of TIR with 28-day mortality.

Conclusions: We found that lower TIR 70-180 mg/dL was associated with a higher 28-day mortality in critically ill patients with HbA1c <6.5%, whereas there was no consistent association in patients with HbA1c ≥6.5%.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158903PMC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252158PLOS

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