AUTHOR=Lu Zongqing , Tao Gan , Sun Xiaoyu , Zhang Yijun , Jiang Mengke , Liu Yu , Ling Meng , Zhang Jin , Xiao Wenyan , Hua Tianfeng , Zhu Huaqing , Yang Min 

TITLE=Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.857368

DOI=10.3389/fpubh.2022.857368

ISSN=2296-2565

ABSTRACT=Background: There was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the optimal MBG range.
Methods: Sepsis patients were enrolled from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). MBG and glycemic coefficient of variation (GluCV) were respectively calculated to represent the overall glycemic status and GV during ICU stay. The associations between MBG, GluCV, and ICU mortality of septic patients were assessed by using multivariate logistic regression in different subgroups and severity of sepsis. Restricted cubic splines evaluated the optimal MBG target.
Results: A total of 7104 adult sepsis patients were included. Multivariate logistic regression results showed that increased MBG and GluCV were significantly correlated with ICU mortality, the adjusted odds ratios were 1.14 (95%CI 1.09-1.20) and 1.05 (95%CI 1.00-1.12). However, there was no association between hyperglycemia and ICU mortality among diabetes, liver disease, immunosuppression, and hypoglycemia patients. And the impact of high GluCV on ICU mortality was not observed in those with diabetes, immunosuppression, liver disease, and non-septic shock. The ICU mortality risk of severe hyperglycemia (≧200mg/dL) and high GluCV (>31.429%) respectively elevated 2.30, 3.15, 3.06 and 2.37, 2.79, 3.14 fold in mild (SOFA≦3), middle (SOFA 3-7) and severe group (SOFA≧7). MBG level was associated with the lowest risk of ICU mortality and hypoglycemia between 120-140 mg/dL in the subgroup without diabetes. For the diabetic subset, the incidence of hypoglycemia was significantly reduced when MBG was 140-190 mg/dL, but a glycemic control target effectively reducing the ICU mortality was not observed. 
Conclusion: MBG and GluCV during the ICU stay were associated with the all-cause ICU mortality in sepsis patients; however, their harms are not apparent in some particular subgroups. The impact of hyperglycemia and high GV on death increased with the severity of sepsis. The risk of ICU mortality and hypoglycemia of those with no pre-existing diabetes was lower when maintaining the MBG in the range of 120-140mg/dL.