Average daily risk range as a measure of glycemic risk is associated with mortality in the intensive care unit

A retrospective study in a burn intensive care unit

Leon S. Farhy, Edward A. Ortiz, Boris P. Kovatchev, Alejandra G. Mora, Steven Wolf, Charles E. Wade

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Although tight glycemic control has been associated with improved outcomes in the intensive care unit (ICU), glycemic variability may be the influential factor in mortality. The main goal of the study was to relate blood glucose (BG) variability of burn ICU patients to outcomes using a sensitive measure of glycemic variability, the average daily risk range (ADRR). Method: Data from patients admitted to a burn ICU were used. Patients were matched by total body surface area (TBSA) and injury severity score (ISS) to test whether increased BG variability measured by ADRR was associated with higher mortality risk and whether we could identify ADRR-based classifications associated with the degree of risk. Results: Four ADRR classifications were identified: low risk, medium-low, medium-high, and high. Mortality progressively increased from 25% in the low-risk group to over 60% in the high-risk group (p < .001). In a post hoc analysis, age also contributed to outcome. Younger (age < 43 years) survivors and nonsurvivors matched by TBSA and ISS had no significant diference in age, mean BG or standard deviation of BG; however, nonsurvivors had higher ADRR (p < .01). Conclusions: Independent of injury severity, glycemic variability measured by the ADRR was significantly associated with mortality in the ICU. When age was considered, ADRR was the only measure of glycemia significantly associated with mortality in younger patients with burns.

Original languageEnglish (US)
Pages (from-to)1087-1098
Number of pages12
JournalJournal of diabetes science and technology
Volume5
Issue number5
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

Fingerprint

Intensive care units
Intensive Care Units
Retrospective Studies
Mortality
Glucose
Blood Glucose
Blood
Injury Severity Score
Body Surface Area
Burns
Survivors

Keywords

  • Average daily risk range
  • Burn
  • Critical illness
  • Glucose control
  • Glucose variability
  • Glycemic risk

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Bioengineering
  • Biomedical Engineering

Cite this

Average daily risk range as a measure of glycemic risk is associated with mortality in the intensive care unit : A retrospective study in a burn intensive care unit. / Farhy, Leon S.; Ortiz, Edward A.; Kovatchev, Boris P.; Mora, Alejandra G.; Wolf, Steven; Wade, Charles E.

In: Journal of diabetes science and technology, Vol. 5, No. 5, 01.01.2011, p. 1087-1098.

Research output: Contribution to journalArticle

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abstract = "Background: Although tight glycemic control has been associated with improved outcomes in the intensive care unit (ICU), glycemic variability may be the influential factor in mortality. The main goal of the study was to relate blood glucose (BG) variability of burn ICU patients to outcomes using a sensitive measure of glycemic variability, the average daily risk range (ADRR). Method: Data from patients admitted to a burn ICU were used. Patients were matched by total body surface area (TBSA) and injury severity score (ISS) to test whether increased BG variability measured by ADRR was associated with higher mortality risk and whether we could identify ADRR-based classifications associated with the degree of risk. Results: Four ADRR classifications were identified: low risk, medium-low, medium-high, and high. Mortality progressively increased from 25{\%} in the low-risk group to over 60{\%} in the high-risk group (p < .001). In a post hoc analysis, age also contributed to outcome. Younger (age < 43 years) survivors and nonsurvivors matched by TBSA and ISS had no significant diference in age, mean BG or standard deviation of BG; however, nonsurvivors had higher ADRR (p < .01). Conclusions: Independent of injury severity, glycemic variability measured by the ADRR was significantly associated with mortality in the ICU. When age was considered, ADRR was the only measure of glycemia significantly associated with mortality in younger patients with burns.",
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N2 - Background: Although tight glycemic control has been associated with improved outcomes in the intensive care unit (ICU), glycemic variability may be the influential factor in mortality. The main goal of the study was to relate blood glucose (BG) variability of burn ICU patients to outcomes using a sensitive measure of glycemic variability, the average daily risk range (ADRR). Method: Data from patients admitted to a burn ICU were used. Patients were matched by total body surface area (TBSA) and injury severity score (ISS) to test whether increased BG variability measured by ADRR was associated with higher mortality risk and whether we could identify ADRR-based classifications associated with the degree of risk. Results: Four ADRR classifications were identified: low risk, medium-low, medium-high, and high. Mortality progressively increased from 25% in the low-risk group to over 60% in the high-risk group (p < .001). In a post hoc analysis, age also contributed to outcome. Younger (age < 43 years) survivors and nonsurvivors matched by TBSA and ISS had no significant diference in age, mean BG or standard deviation of BG; however, nonsurvivors had higher ADRR (p < .01). Conclusions: Independent of injury severity, glycemic variability measured by the ADRR was significantly associated with mortality in the ICU. When age was considered, ADRR was the only measure of glycemia significantly associated with mortality in younger patients with burns.

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