Which variables affect strict glycaemic control with intensive insulin therapy in postoperative/post-traumatic critically ill patients?

Introduction

This study was performed to determine the effect variables supposed to affect optimal blood glucose concentrations between 80 and 150 mg/dl in postoperative/post-traumatic patients.

Methods

From January 2007 to December 2007, 826 postoperative/post-traumatic critically ill patients admitted to a university adult ICU performing intensive insulin therapy were surveyed daily using computer assistance with respect to minimal and maximal daily blood glucose concentrations and insulin therapy. The variables age, sex, sepsis, neurosurgical patient, steroids, adrenaline and/or noradrenaline infusion rate, acute renal failure, liver function assessed by the Model of Endstage Liver Disease score [1], organ dysfunctions reflected by the Sequential Organ Failure Assessment score [2], and severity of disease by the Simplified Acute Physiology Score II [3] were monitored.

Results

Seven hundred and sixty-four patients with an ICU stay >48 hours were eligible for evaluation. In multiple logistic regression with backward elimination to determine the most relevant parameters, sepsis (OR = 1.2, with corresponding 95% CI = 1.1 to 1.4), neurosurgical patients (OR = 1.6, CI = 1.3 to 1.9), steroids (OR = 1.5, CI = 1.2 to 1.9), noradrenaline infusion (OR = 1.4, 95% CI = 1.2 to 1.6), and age (per year) (OR = 1.02, CI = 1.01 to 1.02) were associated with an increased risk not to lay within an optimal blood glucose range of 80 to 150 mg/dl (P < 0.01).

Conclusion

Sepsis, neurosurgery, steroids, catecholamine infusions and age may be associated with increased risk for difficult blood glucose control in postoperative/post-traumatic patients.