Response: Predicting Mortality of Critically Ill Patients by Blood Glucose Levels (Diabetes Metab J 2013;37:385-90)

Byung Sam Park; Ji Sung Yoon

doi:10.4093/dmj.2014.38.1.81

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Response Response: Predicting Mortality of Critically Ill Patients by Blood Glucose Levels (Diabetes Metab J 2013;37:385-90): Byung Sam Park, Ji Sung Yoon; Diabetes & Metabolism Journal 2014;38(1):81-82.
DOI: https://doi.org/10.4093/dmj.2014.38.1.81
Published online: February 19, 2014

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Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

Corresponding author: Ji Sung Yoon. Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea. jsyoon9@ynu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

We appreciate your interests and comments on our study, "Predicting mortality of critically ill patients by blood glucose levels" which was published in Diabetes & Metabolism Journal 2013;37:385-90 [1].

As you mentioned, previous several studies demonstrated that the association of hyperglycemia and mortality was greater in individuals without known diabetes in comparison to those with known diabetes [2-4]. It was also reported that intensive glucose control improved the outcome of prolonged critically ill patients without known diabetes, but showed no survival benefits in those with known diabetes [5]. In their studies, glucose values were defined as mean glucose values throughout the entire intensive care unit (ICU) stay, which is in contrast with our study where we used the glucose values at the day of ICU admission. There appears to be some differences in the significance of hyperglycemia during ICU stay and at the day of ICU admission, partly in terms of its sustainability. Sustained uncontrolled hyperglycemia in nondiabetic subjects during ICU stay could implicate the effect of more critically ill conditions than that found in diabetic subjects and might be more harmful to the subjects who have not been previously exposed to hyperglycemia. However, our study was intended to evaluate whether single dysglycemia at the day of ICU admission, regardless of its sustainability, had a predictive value for hospital mortality. Lepper et al. [6] also used single random glucose concentration on admission in patients with pneumonia and showed that patients with pre-existing diabetes had a significantly increased overall mortality compared with those without diabetes (crude hazard ratio, 2.47; 95% confidence interval, 2.05 to 2.98; P<0.001). This result could be consistent with and support our result which suggest that acute dysregulation of glucose metabolism have an impact on mortality in critically ill subjects regardless of presence of diabetes.

It is now well known that hypoglycemia increase mortality, especially in critically ill patients [7,8]. Therefore, it is important to evaluate the association between hypoglycemia and mortality. It was unfortunate that a subgroup analysis within group 1 (below 100 mg/dL) could not be conducted due to limitation of the number of subjects. However, it is supposed that the increased risk of hypoglycemia in group 1 may have contributed to increased mortality of this group.

We hope to conduct a well-organized study to clarify the relationship between dysglycemia and mortality in critically ill patients. I appreciate again for your interests and crucial comments.

NOTES

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Park BS, Yoon JS, Moon JS, Won KC, Lee HW. Predicting mortality of critically ill patients by blood glucose levels. Diabetes Metab J 2013;37:385-390. Article PubMed PMC
2. Falciglia M, Freyberg RW, Almenoff PL, D'Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 2009;37:3001-3009. Article PubMed PMC
3. Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Hegarty C, Bailey M. Blood glucose concentration and outcome of critical illness: the impact of diabetes. Crit Care Med 2008;36:2249-2255. Article PubMed
4. Krinsley JS, Meyfroidt G, van den Berghe G, Egi M, Bellomo R. The impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients. Curr Opin Clin Nutr Metab Care 2012;15:151-160. Article PubMed
5. Van den Berghe G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, Bouillon R, Schetz M. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes 2006;55:3151-3159. PubMed
6. Lepper PM, Ott S, Nuesch E, von Eynatten M, Schumann C, Pletz MW, Mealing NM, Welte T, Bauer TT, Suttorp N, Juni P, Bals R, Rohde G. German Community Acquired Pneumonia Competence Network. Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study. BMJ 2012;344:e3397Article PubMed PMC
7. NICE-SUGAR Study Investigators. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283-1297. Article PubMed
8. Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C. ANZICS CORE Management Committee. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care 2009;13:R91Article PubMed PMC

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Response: Predicting Mortality of Critically Ill Patients by Blood Glucose Levels (Diabetes Metab J 2013;37:385-90)

Diabetes Metab J. 2014;38(1):81-82. Published online February 19, 2014

DOI: https://doi.org/10.4093/dmj.2014.38.1.81

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