Mild hypoglycemia is strongly associated with increased intensive care unit length of stay

Abstract

ABSTRACT: BACKGROUND: Hypoglycemia is associated with increased mortality in critically ill patients. The impact of hypoglycemia on resource utilization has not been investigated. The objective of this investigation was to evaluate the association of hypoglycemia, defined as a blood glucose concentration (BG) < 70 mg/dL, and intensive care unit (ICU) length of stay (LOS) in 3 different cohorts of critically ill patients. METHODS: This is a retrospective investigation of prospectively collected data including patients from 2 large observational cohorts - 3,263 patients admitted to Stamford Hospital (ST) and 2,063 patients admitted to 3 institutions in The Netherlands (NL) as well as 914 patients from the GLUCONTROL trial (GL), a multi-center prospective randomized controlled trial of intensive insulin therapy. RESULTS: Patients with hypoglycemia were more likely to be diabetic, had higher APACHE II scores and higher mortality than did patients without hypoglycemia. Patients with hypoglycemia had longer ICU LOS (median [interquartile range]) in ST (3.0 [1.4 - 7.1] vs. 1.2 [0.8 - 2.3] days, P < 0.0001), NL (5.2 [2.6 - 10.3] vs. 2.0 [1.3 - 3.2] days, P < 0.0001) and GL (9 [5 - 17] vs. 5 [3 - 9] days, P < 0.0001). This was a consistent finding even when patients were stratified by severity of illness or survivor status. Also, there was a strong positive relation between the number of episodes of hypoglycemia and ICU LOS among all 3 cohorts. CONCLUSIONS: This multi-center international investigation demonstrated that hypoglycemia was consistently associated with significantly higher ICU LOS in heterogeneous cohorts of critically ill patients, independently of severity of illness and survivor status. More effective methods to prevent hypoglycemia in these patients may positively impact their cost of care. KEYWORDS: Hypoglycemia, intensive care unit, length of stay, resource utilization, APACHE II, mortality, intensive insulin therapy.