Objective: Dysglycemia during an intensive care unit (ICU) stay has been correlated with hospital complications and increased mortality. The objective of this study was to examine how glucose derangements during an ICU admission affect length of stay (LOS) and mortality in patients with and without diabetes mellitus.
Methods: Patient-level data for adults (>/=18 years old) admitted to any ICU within our hospital system for at least 24 hours between 5/5/2011 to 11/6/2017 (6.5 years) were pulled from the electronic database. Patients were categorized into four glucose groups: 1) no hyper/hypoglycemia, 2) hyperglycemia only (blood glucose [BG] >180mg/dL), 3) hypoglycemia only (BG <70mg/dL), and 4) both hyper/hypoglycemia. Diabetes status was determined from diagnosis codes prior to the ICU stay. Dates of hospitalization were used to calculate LOS in days. Mortality was examined through the end of the analysis period.
Results: A total of 16,345 encounters were included in this analysis (mean age 57.7 years); only a few patients had multiple encounters. Over one-quarter of patients had diabetes (26.1%). A majority of encounters involved some form of dysglycemia: 16.4% hypoglycemia, 42.4% hyperglycemia, and 12.0% with both hyper/hypoglycemia. The overall average LOS was 6.03 days. Patients without diabetes but with any form of dysglycemia had longer LOS and higher mortality compared to patients with diabetes. Patients with both hyper/hypoglycemia had the least favorable outcomes (no diabetes vs. diabetes, LOS mean±SD: 16.2±23.5 vs. 12.9±16.3 days, p <0.01; mortality: 64.9% vs. 43.6%, p <0.01). Conversely, those with diabetes without any dysglycemia had the shortest LOS and lowest mortality (LOS 2.5±3.2; mortality 11.3%).
Conclusion: Glucose derangements in the ICU were associated with longer LOS in all patients. However, ICU patients without diabetes but with dysglycemia had longer LOS and higher mortality compared to patients with diabetes.
A. Zaman: None. M.T. McDermott: Advisory Panel; Self; Novo Nordisk Inc., Savvy Sherpa. V.V. Mansfield: Employee; Self; UnitedHealth Group. C.C. Low Wang: Research Support; Self; CellResearch Corporation.
UnitedHealth Group; University of Colorado Health Care Innovation Center