High Glucose Variability Increases Mortality Risk in Hospitalized Patients.

High Glucose Variability Increases Mortality Risk in Hospitalized Patients.

J Clin Endocrinol Metab. 2017 Mar 22;:

Authors: Akirov A, Diker-Cohen T, Masri-Iraqi H, Shimon I

Abstract
Context: Glucose variability (GV) is common among hospitalized patients but the prognostic implications are not understood.
Objective: Investigate the association between GV, length of stay (LOS) and mortality.
Methods: GV was assessed by coefficient of variance (CV) and standard deviation (SD) of glucose values during hospitalization.
Setting: Historical prospectively collected data of patients hospitalized between January 2011-December 2013.
Patients: Patients ≥18 years.
Main outcome: LOS, in-hospital and end-of-follow-up mortality.
Results: Cohort included 20,303 patients (mean age 70±17 years, 51% male, median follow-up 1,022 days); 8,565 (42%) patients with diabetes mellitus (DM). Mean LOS was longer with higher CV or SD tertiles in patients without and with DM. In-hospital mortality was 8.2%, associated with higher tertiles of CV (4%, 10%, 19%) and SD (4%, 11%, 21%) in patients without DM and with DM (3%, 5%, 10% and 2%, 4%, 9%, respectively). Mortality at the end-of-follow-up was increased in patients without DM with higher CV (28%, 42%, 55%) and SD (28%, 44%, 57%) tertiles and in patients with DM (26%, 35%, 45% and 25%, 34%, 44%, respectively). Multivariate analysis indicated increased risk for in-hospital and end-of-follow-up mortality, in both groups. Adjustment for glucocorticoid treatment or hypoglycemia did not affect the results. Glucose levels during hospitalization and GV were two independent factors affecting LOS and in-hospital mortality. In each CV tertile, mortality was higher with median glucose ≥180mg/dl, compared with <180mg/dl.
Conclusions: In hospitalized patients with and without DM, increased GV is associated with longer hospitalization and increased short- and long-term mortality.

PMID: 28368484 [PubMed - as supplied by publisher]

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