| Title |
Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality
|
|---|---|
| Published in |
Intensive Care Medicine, February 2016
|
| DOI | 10.1007/s00134-016-4216-8 |
| Pubmed ID | |
| Authors |
Moritoki Egi, James S. Krinsley, Paula Maurer, Devendra N. Amin, Tomoyuki Kanazawa, Shruti Ghandi, Kiyoshi Morita, Michael Bailey, Rinaldo Bellomo |
| Abstract |
To study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit (ICU) patients and subsequent hospital mortality in critically ill patients. We performed a multicenter, multinational, retrospective observational study of patients with available HbA1c levels within the 3-month period preceding ICU admission. We separated patients into three cohorts according to pre-admission HbA1c levels (<6.5, 6.5-7.9, ≥8.0 %, respectively). Based on published data, we defined a glucose concentration of 40-69 mg/dL (2.2-3.8 mmol/L) as moderate hypoglycemia and <40 mg/dL (<2.2 mmol/L) as severe hypoglycemia. We applied logistic regression analysis to study the impact of pre-morbid glycemic control on the relationship between acute hypoglycemia and mortality. A total of 3084 critically ill patients were enrolled in the study. Among these patients, with increasing HbA1c levels from <6.5, to 6.5-7.9, and to ≥8.0 %, the incidence of both moderate (3.8, 11.1, and 16.4 %, respectively; p < 0.001) and severe (0.9, 2.5, and 4.3 %, respectively; p < 0.001) hypoglycemia progressively and significantly increased. The relationship between the occurrence of hypoglycemic episodes in the ICU and in-hospital mortality was independently and significantly affected by pre-morbid glucose control, as assessed by adjusted odds ratio (OR) and 95 % confidence interval (CI) for hospital mortality: (1) moderate hypoglycemia: in patients with <6.5, 6.5-7.9, and ≥8.0 % of HbA1c level-OR 0.54, 95 % CI 0.25-1.16; OR 0.82, 95 % CI 0.33-2.05; OR 3.42, 95 % CI 1.29-9.06, respectively; (2) severe hypoglycemia: OR 1.50, 95 % CI 0.42-5.33; OR 1.59, 95 % CI 0.36-7.10; OR 23.46, 95 % CI 5.13-107.28, respectively (interaction with pre-morbid glucose control, p = 0.009). We found that the higher the glucose level before admission to the ICU, the higher the mortality risk when patients experienced hypoglycemia. In critically ill patients, chronic pre-morbid hyperglycemia increases the risk of hypoglycemia and modifies the association between acute hypoglycemia and mortality. |
X Demographics
The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Nepal | 2 | 20% |
| United States | 2 | 20% |
| Australia | 1 | 10% |
| United Kingdom | 1 | 10% |
| Unknown | 4 | 40% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 60% |
| Scientists | 4 | 40% |
Mendeley readers
The data shown below were compiled from readership statistics for 66 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 2% |
| United States | 1 | 2% |
| Unknown | 64 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 9 | 14% |
| Researcher | 8 | 12% |
| Student > Postgraduate | 7 | 11% |
| Student > Master | 7 | 11% |
| Other | 5 | 8% |
| Other | 20 | 30% |
| Unknown | 10 | 15% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 33 | 50% |
| Nursing and Health Professions | 7 | 11% |
| Computer Science | 3 | 5% |
| Engineering | 3 | 5% |
| Agricultural and Biological Sciences | 2 | 3% |
| Other | 4 | 6% |
| Unknown | 14 | 21% |
Attention Score in Context
This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 05 December 2017.
All research outputs
#6,183,082
of 24,178,331 outputs
Outputs from Intensive Care Medicine
#2,631
of 5,215 outputs
Outputs of similar age
#96,434
of 405,556 outputs
Outputs of similar age from Intensive Care Medicine
#34
of 100 outputs
Altmetric has tracked 24,178,331 research outputs across all sources so far. This one has received more attention than most of these and is in the 74th percentile.
So far Altmetric has tracked 5,215 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 28.9. This one is in the 49th percentile – i.e., 49% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 405,556 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 76% of its contemporaries.
We're also able to compare this research output to 100 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 67% of its contemporaries.