Risk Factors for Hypoglycaemia in Neurocritical Care Patients

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2012 Aug 22

PMID 22907674

Citations 3

Authors

Freya M van Iersel

Arjen J C Slooter

Renee Vroegop

Annemiek E Wolters

Charlotte A M Tiemessen

Rik H J Rosken

Johannes G van der Hoeven

Linda M Peelen

Cornelia W E Hoedemaekers

Affiliations

Soon will be listed here.

Abstract

Purpose: To identify risk factors for hypoglycaemia in neurocritical care patients receiving intensive insulin therapy (IIT).

Methods: We performed a nested case-control study. All first episodes of hypoglycaemia (glucose <80 mg/dL, <4.4 mmol/L) in neurocritical care patients between 1 March 2006 and 31 December 2007 were identified. Patients were treated according to the local IIT protocol, with target blood glucose levels between 4.5 and 6.0 mmol/L (81.0-108.0 mg/dL). The first hypoglycaemic event of every patient (index moment) was used to match to a control patient. Possible risk factors preceding the index moment were scored using hospital records and analysed with conditional logistic regression.

Results: Of 786 neurocritical care patients, 449 developed hypoglycaemia (57.1 %). Independent risk factors for hypoglycaemia were lowering nutrition 6 h before the index moment without insulin dose reduction (odds ratio (OR) 5.25, 95 % confidence interval (95 % CI) 1.32-20.88), mechanical ventilation (OR 2.59, 95 % CI 1.56-4.29), lowering the dosage of norepinephrine 3 h before the index moment (OR 2.44, 95 % CI 1.07-5.55), a hyperglycaemic event (>10 mmol/L, >180.0 mg/dL) in the 24 h preceding the index moment (OR 2.40, 95 % CI 1.26-4.58), gastric residual in the 6 h preceding the index moment without insulin dose reduction (OR 1.76, 95 % CI 1.05-2.96) and dosage of insulin at the index moment (OR 0.83, 95 % CI 0.76-0.90).

Conclusion: Hypoglycaemia occurs in a considerable proportion of neurocritical care patients. We recommend the identification of these risk factors in these patients to avoid the occurrence of hypoglycaemia.

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References

Tiemessen C, Hoedemaekers C, van Iersel F, Rosken G, van der Hoeven J, Biessels G . Intensive insulin therapy increases the risk of hypoglycemia in neurocritical care patients. J Neurosurg Anesthesiol. 2011; 23(3):206-14. DOI: 10.1097/ANA.0b013e31821aa6f2. View

Shan L, Hao P, Chen Y . Efficacy and safety of intensive insulin therapy for critically ill neurologic patients: a meta-analysis. J Trauma. 2011; 71(5):1460-4. DOI: 10.1097/TA.0b013e3182250515. View

Thiele R, Pouratian N, Zuo Z, Scalzo D, Dobbs H, Dumont A . Strict glucose control does not affect mortality after aneurysmal subarachnoid hemorrhage. Anesthesiology. 2009; 110(3):603-10. DOI: 10.1097/ALN.0b013e318198006a. View

Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G . Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control. Intensive Care Med. 2010; 36(2):196-209. PMC: 2816797. DOI: 10.1007/s00134-009-1742-7. View

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View

Schlenk F, Nagel A, Graetz D, Sarrafzadeh A . Hyperglycemia and cerebral glucose in aneurysmal subarachnoid hemorrhage. Intensive Care Med. 2008; 34(7):1200-7. DOI: 10.1007/s00134-008-1044-5. View

Arabi Y, Tamim H, Rishu A . Hypoglycemia with intensive insulin therapy in critically ill patients: predisposing factors and association with mortality. Crit Care Med. 2009; 37(9):2536-44. DOI: 10.1097/CCM.0b013e3181a381ad. View

Green D, OPhelan K, Bassin S, Chang C, Stern T, Asai S . Intensive versus conventional insulin therapy in critically ill neurologic patients. Neurocrit Care. 2010; 13(3):299-306. DOI: 10.1007/s12028-010-9417-3. View

Su Y, Li X, Li S, Luo R, Ding J, Wang L . Predicting hospital mortality using APACHE II scores in neurocritically ill patients: a prospective study. J Neurol. 2009; 256(9):1427-33. DOI: 10.1007/s00415-009-5129-z. View

10.

Bilotta F, Caramia R, Cernak I, Paoloni F, Doronzio A, Cuzzone V . Intensive insulin therapy after severe traumatic brain injury: a randomized clinical trial. Neurocrit Care. 2008; 9(2):159-66. DOI: 10.1007/s12028-008-9084-9. View

11.

Wiener R, Wiener D, Larson R . Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008; 300(8):933-44. DOI: 10.1001/jama.300.8.933. View

12.

Oksanen T, Skrifvars M, Varpula T, Kuitunen A, Pettila V, Nurmi J . Strict versus moderate glucose control after resuscitation from ventricular fibrillation. Intensive Care Med. 2007; 33(12):2093-100. DOI: 10.1007/s00134-007-0876-8. View

13.

Brunkhorst F, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N . Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008; 358(2):125-39. DOI: 10.1056/NEJMoa070716. View

14.

Krinsley J, Grover A . Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007; 35(10):2262-7. DOI: 10.1097/01.CCM.0000282073.98414.4B. View

15.

Johnston K, Hall C, Kissela B, Bleck T, Conaway M . Glucose Regulation in Acute Stroke Patients (GRASP) trial: a randomized pilot trial. Stroke. 2009; 40(12):3804-9. PMC: 2790382. DOI: 10.1161/STROKEAHA.109.561498. View

16.

Eslami S, Abu-Hanna A, de Keizer N, Bosman R, Spronk P, de Jonge E . Implementing glucose control in intensive care: a multicenter trial using statistical process control. Intensive Care Med. 2010; 36(9):1556-65. PMC: 2926931. DOI: 10.1007/s00134-010-1924-3. View

17.

Kreisel S, Berschin U, Hammes H, Leweling H, Bertsch T, Hennerici M . Pragmatic management of hyperglycaemia in acute ischaemic stroke: safety and feasibility of intensive intravenous insulin treatment. Cerebrovasc Dis. 2008; 27(2):167-75. DOI: 10.1159/000185608. View

18.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

19.

Schlenk F, Vajkoczy P, Sarrafzadeh A . Inpatient hyperglycemia following aneurysmal subarachnoid hemorrhage: relation to cerebral metabolism and outcome. Neurocrit Care. 2009; 11(1):56-63. DOI: 10.1007/s12028-009-9222-z. View

20.

Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters P, Milants I . Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354(5):449-61. DOI: 10.1056/NEJMoa052521. View