Glycemic variability and mortality in critically ill patients: higher risk in non-diabetic patients

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Objective: Glycemic variability (GV) is associated with increased morbidity and mortality in critically ill patients. This study aimed to contribute to the knowledge on the subject and to investigate the situation in our intensive care patient population. Method: Patients who were admitted to the Intensive Care Unit (ICU) between January 2015 and August 2020 were screened using the hospital’s database. The following data were collected: demographic characteristics of the patients, comorbidities, APACHE II scores, SOFA scores, mean amplitude of glycemic excursions (MAGE) based on daily blood glucose measurements from the first day of ICU admission until discharge up to the 28th day of their stay, length of stay (LOS), and 28-day mortality status. Results: In this study, 136 patients were enrolled and divided into high (n=70) and low GV (n=66). No differences were found between the two groups in terms of age, gender, comorbidity, APACHE II, mean SOFA scores, treatments, ICU LOS, and mortality. MAGE was higher in nonsurvivors (78.8 ±32.2) compared to survivors (65.4 ±22.5) (t=-2.78, p= 0.005). Regarding the mortality, the AUC value for GV was 0.611 (p=0.02) for MAGE >61 mg/dl, with a sensitivity of 68.5% and specificity of 50%. Patients were grouped according to GV (MAGE>65) and the presence of diabetes mellitus (DM). Mortality was highest in patients with high GV and without DM (53.3%). Conclusion: In this study, MAGE levels were higher in non-survivors than survivors, and glycemic variability was moderately associated with mortality. Patients with high GV and without DM had a higher mortality rate compared to those with DM.

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