Skip to main content

Hydrocortisone increases the risk of dysglycemia in critically ill patients

Introduction

Hyperglycemia and hypoglycemia are independently associated with mortality and morbidity of critically ill patients [1, 2]. Critically ill patients frequently receive hydrocortisone for refractory shock. While hydrocortisone infusion is associated with hyperglycemia [3], the effect of hydrocortisone on the incidence of hypoglycemia is uncertain. We hypothesized hydrocortisone infusion to increase the risk of hyperglycemia and hypoglycemia in critically ill patients.

Methods

Blood glucose measurements (n = 73,400) of patients admitted to the ICU from January 2007 to December 2009 (n = 2,167) were analyzed. Logistic regression was used to analyze the effect of hydrocortisone infusion on mild (blood glucose level ≥150 mg/dl) and severe hyperglycemia (≥180 mg/dl) and mild hypoglycemia (≤70 mg/dl) separately. To adjust for severity of disease, patients were stratified in APACHE II score groups (<15; 15 to 24; >24).

Results

Hydrocortisone infusion was independently associated with mild hypoglycemia (APACHE II score <15, OR 2.40, 95% CI 2.01 to 2.85; APACHE II score 15 to 24, OR 1.53, 95% CI 1.44 to 1.62; APACHE II score >24, OR 1.10, 95% CI 1.05 to 1.15) and severe hyperglycemia in all APACHE II groups (APACHE II score <15, OR 3.26, 95% CI 2.59 to 4.10; APACHE II score 15 to 24 OR 1.45, 95% CI 1.33 to 1.68; and APACHE II score >24 OR 1.09, 95% CI 1.02 to 1.17). Hydrocortisone infusion was independently associated with mild hypoglycemia in patients with APACHE II score 15 to 24 (OR 1.74, 95% CI 1.42 to 2.13) and >24 (OR 1.64, 95% CI 1.42 to 1.90), but not in patients with APACHE II score <15 (OR 1.83, 95% CI 0.94 to 3.55).

Conclusion

Hydrocortisone increases the risk of dysglycemia in critically ill patients. Whether these dysglycemic effects diminish the beneficial effects of hydrocortisone treatment should be investigated in future studies.

References

  1. 1.

    Krinsley JS, et al.: Crit Care Med. 2007, 35: 2262-2267. 10.1097/01.CCM.0000282073.98414.4B

    Article  PubMed  Google Scholar 

  2. 2.

    Bagshaw SM, et al.: Crit Care Med. 2009, 37: 463-470. 10.1097/CCM.0b013e318194b097

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Annane D, et al.: JAMA. 2009, 301: 2362-2375. 10.1001/jama.2009.815

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to RT Van Hooijdonk.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Van Hooijdonk, R., Binnekade, J., Harmsen, R. et al. Hydrocortisone increases the risk of dysglycemia in critically ill patients. Crit Care 16, P157 (2012). https://doi.org/10.1186/cc10764

Download citation

Keywords

  • Hydrocortisone
  • Blood Glucose
  • Glucose Level
  • Emergency Medicine
  • Hyperglycemia