Malglycemia in the critical care setting. Part I: Defining hyperglycemia in the critical care setting using the glycemic ratio
Authors' conclusion
Clinically significant SIH commenced above GR 1.1. Mortality was associated with hours of exposure to GR ≥ 1.1 which was a superior marker of SIH compared to BG.
Study context
- Population
- Adults in a medical-surgical ICU with hemoglobin A1c (HbA1c) and at least four Blood Glucose (BGs)
- Participants
- 4,790 adults
- Exposure
- Hours of exposure to Glycemic Ratio (GR) ≥ 1.1 vs hours of BG ≥ 180 mg/dL as markers of stress-induced hyperglycemia
- Outcome
- In-hospital mortality
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
In-hospital mortality (risk-adjusted)
Odds ratio (95% CI)P value
Hours GR ≥ 1.1
1.0014(1.0003–1.0026)
P = 0.0161Hours BG ≥ 180 mg/dL
1.0080(1.0034–1.0126)
P = 0.0006- Critical stress-induced hyperglycemia (SIH) threshold identified at GR
- 1.1
- Mortality increased with increasing exposure to GR ≥ 1.1 (r2 = 0.94)
- P = 0.0007
- Less robust association of duration of BG ≥ 180 mg/dL with mortality (r2 = 0.75)
- P = 0.059
Observational data: associations, not effects.
Further findings
In-hospital mortality, cohort with no exposure to hypoglycemia (subgroup)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Hours GR ≥ 1.1 | 1.0027 (1.0012–1.0043) | P = 0.0007 | |
| Hours BG ≥ 180 mg/dL | 1.0031 (0.9949–1.0114) | P = 0.50 | |
| 0.512Odds ratio (log scale) |
In-hospital mortality, never BG outside 70-180 mg/dL (subgroup, n = 2494)
- Association of hours GR ≥ 1.1 with mortality remained intact
Original publication
Malglycemia in the critical care setting. Part I: Defining hyperglycemia in the critical care setting using the glycemic ratio. J Crit Care. Published 12 May 2023. doi:10.
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