Journal Article

The effect of glucose variability on the development of chronic critical illness and mortality in critically-ill COVID-19 patients

Abbasoglu, Osman, Ersoy, Ebru Ortac, Yorganci, Kaya, Topeli, Arzu, Tanilir, Ahmet Berat

2024

Overview

High glycemic variability (GV) is common in critically-ill patients; however, its association with development of chronic critical illness (CCI) and mortality remains unclear. The aim of this study is to determine the effect of GV, on the development of CCI and mortality in critically-ill COVID-19 patients. This study is a retrospective observational study including adult critically-ill COVID-19 patients consecutively admitted to the Medical ICU between 20th March 2020 and 15th June 2021 who had at least three blood glucose measurements on admission day. CCI was defined as ICU length of stay ≥14 days, cardiovascular SOFA score ≥ 1, and other SOFA parameters ≥2 on day 14. In each patient, the mean and SD of blood glucose concentration during ICU stay were calculated. To evaluate variability, the coefficient of variability (GluCV = GluSD / GluMEAN) and mean glucose difference (MGD) (absolute max-min) were calculated for each patient. We also recorded mean, SD, and maximum blood glucose concentrations in the first 7 days of ICU stay. 397 confirmed COVID-19 patients were admitted to the ICU during the study period. Among them, 157 patients had at least three blood glucose samples on admission day. Mean age was 65.1 ± 14.8, mean APACHE II was 17.6 ± 7.6, mean admission SOFA score was 5.5 ± 3.3. 44.6% of the patients developed CCI. 43.9% patients died in the ICU. On the first day of ICU admission, mean glucose level was 165.9 ± 60.1 mg/dL, SD was 30.4 ± 40.1, CV was 17.1 ± 17.1%, and MGD was 50.1 ± 54.6 mg/dL. First week mean glucose level was 165.4 ± 46.9 mg/dL, SD was 47.2 ± 29.5, CV was 27.2 ± 13.8%, and MGD was 156.9 ± 109.6 mg/dL. Comparisons of glycemic variability parameters between patients with CCI and without CCI were not different (p > 0.05 for all). MGD in the first day was higher in patients who died compared to survived patients (60.4 ± 70.1 vs 42.1 ± 45.4, respectively; p = 0.027). First week glycemic variability parameters were higher in patients who died compared to patients who survived: SD 55.5 ± 32.4 vs 40.5 ± 25.3, p = 0.003; CV30.5 ± 15.7 vs 24.6 ± 11.5, p = 0.026; MGD 191.9 ± 119.1 vs 129.5 ± 93.5, p < 0.001. Glucose variability was not found to be associated with the development of CCI but higher glucose variability was associated with ICU mortality in critically-ill COVID-19 patients.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Chronic critical illness / COVID-19 / Critical care / Glucose / Glucose variability / Intensive care / Mortality / Patients