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The metrics of glycaemic control in critical care.

Abstract：

INTRODUCTION:Trials of tight glucose control have compared measures of central tendency, such as average blood glucose, and yielded conflicting results. Other metrics, such as standard deviation, reflect different properties of glucose control and are also associated with changes in outcome. It is possible, therefore, that the conflicting results from interventional studies arise from effects on glycaemic control that have not been reported. METHODS:Using glucose measurements from patients admitted to four adult intensive care units in one UK hospital, we sought to identify metrics of glycaemic control, examine the relationship between them and identify the metrics that are both independently and most strongly associated with outcome. RESULTS:We examined nine previously described metrics and identified a further four. Cluster analysis classified these metrics into two families, namely, those reflecting measures of central tendency and those reflecting measures of dispersion. A measure of minimum glucose was also identified but related to neither family. Plots of the quintiles of these metrics against hospital mortality revealed population-specific relationships. Areas under receiver-operating characteristic curves could not identify an optimum metric of central tendency or dispersion. Using odds ratios, we were able to show that the effect of these metrics is independent of one another. CONCLUSION:Our results suggest that glycaemic control is associated with outcome on the basis of three independent metrics, reflecting measures of central tendency, measures of dispersion and a measure of minimum glucose.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Mackenzie IM,Whitehouse T,Nightingale PG

doi

10.1007/s00134-010-2103-2

subject

Has Abstract

pub_date

2011-03-01 00:00:00

pages

435-43

issue

3

eissn

0342-4642

issn

1432-1238

journal_volume

37

pub_type

杂志文章

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