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https://hdl.handle.net/2440/102622
Type: | Journal article |
Title: | Prior exposure to hyperglycaemia attenuates the relationship between glycaemic variability during critical illness and mortality |
Author: | Plummer, M. Finnis, M. Horsfall, M. Ly, M. Kar, P. Abdelhamid, Y. Deane, A. |
Citation: | Critical Care and Resuscitation, 2016; 18(3):189-197 |
Publisher: | The Australasian Medical Publishing Company |
Issue Date: | 2016 |
ISSN: | 1441-2772 2652-9335 |
Statement of Responsibility: | Mark P Plummer, Mark E Finnis, Matthew Horsfall, Marleesa Ly, Palash Kar, Yasmine Ali Abdelhamid and Adam M Deane |
Abstract: | Objective: Our primary objective was to determine the impact of prior exposure to hyperglycaemia on the association between glycaemic variability during critical illness and mortality. Our secondary objectives included evaluating the relationships between prior hyperglycaemia and hyperglycaemia or hypoglycaemia during critical illness and mortality. Design and participants: A single-centre, retrospective, observational study in a tertiary intensive care unit. Patients admitted to the ICU between 1 September 2011 and 30 June 2015, with diabetes recorded using ICD-10-AM coding or a glycated haemoglobin (HbA1c) level of >= 6.5%, were stratified by prior hyperglycaemic level (HbA1c < 6.5%, 6.5%-8.5%, or > 8.5%). Main outcome measures: Glycaemic variability was assessed as the blood glucose coefficient of variation during the patient's stay in the ICU. Multivariate logistic regression and marginal predictive plots were used to assess the impact of prior hyperglycaemia on the association between glycaemic metrics and mortality. Results: We studied 1569 patients with diabetes (HbA1c < 6.5%, n = 495; HbA1c 6.5%-8.5%, n = 731; and HbA1c > 8.5%, n = 343). Glycaemic variability was strongly associated with hospital mortality (P = 0.001), but this association showed a significant interaction with prior hyperglycaemia (P = 0.011), such that for patients with HbA1c > 8.5%, increasing glycaemic variability was not associated with increased mortality. Acute hyperglycaemia was strongly associated with mortality (P < 0.0001) and also showed a significant interaction with prior hyperglycaemia (P = 0.001), such that for patients with HbA1c > 8.5%, acute hyperglycaemia was not associated with mortality. Hypoglycaemia was also associated with mortality (P < 0.0001), but prior exposure to hyperglycaemia had a lesser effect on this relationship. Conclusion: Prior exposure to hyperglycaemia attenuates the association between glycaemic variability and mortality in critically ill patients with diabetes. |
Keywords: | Humans Diabetes Mellitus Hyperglycemia Hypoglycemia Critical Illness Blood Glucose Critical Care Hospitalization Hospital Mortality Logistic Models Retrospective Studies Adult Aged Middle Aged Female Male |
Rights: | Copyright status unknown |
Grant ID: | NHMRC |
Published version: | http://search.informit.com.au/documentSummary;dn=313945376955009;res=IELHEA |
Appears in Collections: | Aurora harvest 7 Physics publications |
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