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.