Low blood sugar levels during admission in an Intensive Care Unit (ICU) may more commonly be associated with death, according to a recent study published in the New England Journal of Medicine.
Glucose levels of patients kept in ICUs are continuously monitored and controlled. However, this intensive control of glucose makes the patient more prone to hypoglycemia or low glucose levels. Hypoglycemia in turn could affect mortality of these patients.
AdvertisementA study evaluated mortality associated with hypoglycemia in critically-ill patients admitted in the ICU. The data for the study was obtained from the NICE-SUGAR study database. This study obtained data on 6104 adults admitted to the ICUs of 42 hospitals between the years 2004 and 2008 for 3 or more days.
The participants either underwent intensive blood glucose control, with glucose levels maintained between 81 to 108 mg per deciliter, or conventional glucose control, with a glucose level of 180 mg per deciliter or less. The patients were monitored for several parameters until they were discharged, till 90 days after the beginning of the study or until they died.
Data was obtained at 28 days for 6026 patients and at 90 days for 6022 patients. Analyzing the data obtained at 28 days, the researchers found moderate hypoglycemia (blood glucose levels between 41 and 70 mg per deciliter) in 74.2% patients in the intensive-control group and 15.8% in the conventional-control group. Severe hypoglycemia (blood glucose value of 40 mg per deciliter) was observed in 6.9% patients in the intensive-control group and 0.5% patients in the conventional-control group.
Patients with moderate and severe hypoglycemia were hospitalized for a longer duration as compared to those who did not have hypoglycemia. Deaths were more common in patients who suffered from hypoglycemia. Moderate hypoglycemia was associated with a 40% increased risk of death, while the risk was doubled with severe hypoglycemia. Among the patients with moderate hypoglycemia, the risk for death was higher in patients who had hypoglycemia for more than a day.
Hypoglycemia can increase the chances of death through a number of ways like altering blood flow and causing cardiac arrhythmias. However, this study was not designed to evaluate whether hypoglycemia was the cause of death in these patients. This question therefore remains unanswered.
Thus, in critically ill patients, it is important to avoid hypoglycemia, which may be linked to increased risk for death.
Hypoglycemia and Risk of Death in Critically Ill Patients; The NICE-SUGAR Study Investigators; N Engl J Med 2012; 367:1108-1118