Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU XXXX .

@entity1 @entity413 @entity4053
INTRODUCTION: In a randomized controlled trial comparing tight @entity413 control with a computerized decision support system and conventional protocols (post hoc analysis), we tested the hypothesis that @entity4053 is associated with a poor outcome, even when controlling for initial severity. METHODS: We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) @entity4053 , multiple hypoglycemic events (n >= 3) and the other main components of glycemic control (mean blood @entity413 level and blood @entity413 coefficient of variation (CV)). The primary endpoint was 90-day mortality. We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10(-5) digit with no replacement). RESULTS: A total of 2,601 @entity1 were analyzed and divided into three groups: no @entity4053 (n =1,474), moderate @entity4053 (n =874, 34%) and severe @entity4053 (n =253, 10%). @entity1 with moderate or severe @entity4053 had a poorer prognosis, as shown by a higher mortality rate (36% and 54%, respectively, vs. 28%) and decreased number of treatment-free days. In the multivariable analysis, severe (odds ratio (OR), 1.50; 95% CI, 1.36 to 1.56; P =0.043) and multiple hypoglycemic events (OR, 1.76, 95% CI, 1.31 to 3.37; P <0.001) were significantly associated with mortality, whereas blood @entity413 CV was not. Using multivariable matching, @entity1 with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality. CONCLUSION: In a large cohort of ICU @entity1 , severe @entity4053 and multiple hypoglycemic events were associated with increased 90-day mortality. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01002482 . Registered 26 October 2009.
