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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2011

01-03-2011 | Original

The metrics of glycaemic control in critical care

Authors: Iain M. J. Mackenzie, Tony Whitehouse, Peter G. Nightingale

Published in: Intensive Care Medicine | Issue 3/2011

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Abstract

Introduction

Trials of tight glucose control have compared measures of central tendency, such as average blood glucose, and yielded conflicting results. Other metrics, such as standard deviation, reflect different properties of glucose control and are also associated with changes in outcome. It is possible, therefore, that the conflicting results from interventional studies arise from effects on glycaemic control that have not been reported.

Methods

Using glucose measurements from patients admitted to four adult intensive care units in one UK hospital, we sought to identify metrics of glycaemic control, examine the relationship between them and identify the metrics that are both independently and most strongly associated with outcome.

Results

We examined nine previously described metrics and identified a further four. Cluster analysis classified these metrics into two families, namely, those reflecting measures of central tendency and those reflecting measures of dispersion. A measure of minimum glucose was also identified but related to neither family. Plots of the quintiles of these metrics against hospital mortality revealed population-specific relationships. Areas under receiver-operating characteristic curves could not identify an optimum metric of central tendency or dispersion. Using odds ratios, we were able to show that the effect of these metrics is independent of one another.

Conclusion

Our results suggest that glycaemic control is associated with outcome on the basis of three independent metrics, reflecting measures of central tendency, measures of dispersion and a measure of minimum glucose.
Appendix
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Metadata
Title
The metrics of glycaemic control in critical care
Authors
Iain M. J. Mackenzie
Tony Whitehouse
Peter G. Nightingale
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-2103-2

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