Tight glucose control: is there any influence on outcome? A retrospective cohort study

Introduction

Recent recommendations on tight glucose control in general critically ill patients questioned its effect on patient outcome [1, 2]. The aim of our work is to determine whether the implementation of tight glucose control to our practice improved our patients' outcome.

Methods

In this retrospective cohort study we used baseline data from our intensive care register. An intravenous insulin protocol to maintain tight glucose control was implemented in our practice on 6 June 2003. In the study we enrolled patients admitted to our six-bed multidisciplinary ICU over a 2-year period before (years 2001 and 2002 – group with usual glucose control) and a 2-year period after (years 2004 and 2005 – group with tight glucose control) the introduction of tight glucose control. In total 231 adult mechanically ventilated patients, admitted primarily or within the first 24 hours to our ICU, were included. We recorded the length of ICU stay, length of artificial ventilation, cost, APACHE II and SOFA scores, and examined the incidence of nosocomial infections and mortality in both groups of critically ill patients.

Results

One hundred and fifteen patients in the group with usual glucose control and 116 patients in the group with tight glucose control were analyzed; no significant difference on severity of disease in both groups (APACHE II score 23.7 vs. 24.14, P = 0.765 and SOFA score 7.9 vs. 7.8, P = 0.743) was detected. Tight glucose control was associated with a significant reduction of nosocomial pneumonia (20% vs. 11%, OR = 0.34, 95% CI = 0.19 to 0.86). There was no significant difference in hospital mortality, length of stay, artificial ventilation and cost.

Conclusion

Tight glucose control was associated with a significant reduction of nosocomial pneumonia, but not with a reduction of hospital mortality, length of stay, artificial ventilation and hospital cost.