Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients

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• 作者：Lina Saliba ; PharmD ; BCCCP ; BCPS^a ; Charles H. Cook ; MD ; FACS ; FCCM^b ; Kathleen M. Dungan ; MD ; MPH^c ; Kyle Porter ; MS^d ; Claire V. Murphy ; PharmD ; BCPS^a ; ^{claire.murphy@osumc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Hypoglycemia ; Iatrogenic disease ; Insulin ; Blood glucose ; Intensive care ; Mortality
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：13-17
• 全文大小：277 K

文摘

Hypoglycemia is associated with increased mortality, but the role of its etiology is unclear. This study aimed to examine the impact of hypoglycemia etiology on mortality risk among critically ill patients.

Methods

This single-center, retrospective, cohort study evaluated adult patients admitted to the medical or surgical intensive care unit, who experienced medication-induced or spontaneous hypoglycemia (blood glucose <70 mg/dL) during intensive care unit admission. Patients who became hypoglycemic following receipt of glucose-lowering therapy within a predefined time period were categorized in the medication-induced group. Periods were determined for each agent based on expected pharmacokinetics in critically ill patients. Patients who became hypoglycemic with no identifiable cause were categorized in the spontaneous group. Primary analysis compared medication-induced and spontaneous hypoglycemia with a primary endpoint of all-cause hospital mortality. Secondary analyses stratified patients by diabetes, severity of hypoglycemia, and glycemic variability.

Results

A total of 642 patients were eligible for inclusion (305 medication-induced and 337 spontaneous). When adjusted for covariates, no difference in hospital mortality was observed based on hypoglycemia etiology (odds ratio, 1.22 [0.77-1.93]; P = .39). Regardless of etiology, hypoglycemic severity, frequency, and glycemic variability were significantly associated with higher odds of hospital mortality. Hypoglycemic etiology did not impact hospital mortality when patients were stratified by presence or absence of diabetes.

Conclusions

Medication-induced hypoglycemia appears to be equally harmful as spontaneous hypoglycemia during critical illness. Future studies should aim to identify strategies to minimize hypoglycemia regardless of etiology, while also minimizing glycemic variability associated with hypoglycemia treatment.