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Critical Care

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Open Access 01-10-2008 | Research

The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability

Authors: Reiner M Waeschle, Onnen Moerer, Reinhard Hilgers, Peter Herrmann, Peter Neumann, Michael Quintel

Published in: Critical Care | Issue 5/2008

Abstract

Introduction

The purpose of this study was to assess the relation between glycaemic control and the severity of sepsis in a cohort of patients treated with intensive insulin therapy (IIT).

Methods

In a prospective, observational study, all patients in the intensive care unit (ICU) (n = 191) with sepsis, severe sepsis or septic shock were treated with IIT (target blood glucose (BG) level 80 to 140 mg/dl instead of strict normoglycaemia). BG values were analysed by calculating mean values, rate of BG values within different ranges, rate of patients experiencing BG values within different levels and standard deviation (SD) of BG values as an index of glycaemic variability.

Results

The number of patients with hypoglycaemia and hyperglycaemia was highly dependent on the severity of sepsis (critical hypoglycaemia ≤ 40 mg/dl: sepsis: 2.1%, severe sepsis: 6.0%, septic shock: 11.5%, p = 0.1497; hyperglycaemia: >140 mg/dl: sepsis: 76.6%, severe sepsis: 88.0%, septic shock: 100%, p = 0.0006; >179 mg/dl: sepsis: 55.3%, severe sepsis: 73.5%, septic shock: 88.5%, p = 0.0005; >240 mg/dl: sepsis: 17.0%, severe sepsis: 48.2%, septic shock: 45.9%, p = 0.0011). Multivariate analyses showed a significant association of SD levels with critical hypoglycaemia especially for patients in septic shock (p = 0.0197). In addition, SD levels above 20 mg/dl were associated with a significantly higher mortality rate relative to those with SD levels below 20 mg/dl (24% versus 2.5%, p = 0.0195).

Conclusions

Patients with severe sepsis and septic shock who were given IIT had a high risk of hypoglycaemia and hyperglycaemia. Among these patients even with a higher target BG level, IIT mandates an increased awareness of the occurrence of critical hypoglycaemia, which is related to the severity of the septic episode.

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Title: The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability
Authors: Reiner M Waeschle
Onnen Moerer
Reinhard Hilgers
Peter Herrmann
Peter Neumann
Michael Quintel
Publication date: 01-10-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc7097

At a glance: The STEP trials

Springer Medicine

The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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