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Open Access Research

Mild hypoglycemia is strongly associated with increased intensive care unit length of stay

James Krinsley1*, Marcus J Schultz23, Peter E Spronk24, Floris van Braam Houckgeest5, Johannes P van der Sluijs6, Christian Mélot7 and Jean-Charles Preiser78

Author Affiliations

1 Division of Critical Care, Stamford Hospital, Columbia University College of Physicians and Surgeons, Stamford, CT, USA

2 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

3 Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

4 Department of Intensive Care, Gelre Hospitals, location Lukas, Apeldoorn, The Netherlands

5 Department of Intensive Care, Tergooi Hospitals, location Blaricum, Blaricum, The Netherlands

6 Department of Intensive Care Medicine, Medical Center Haaglanden, The Hague, The Netherlands

7 Department of Intensive Care, Erasme University Hospital, Brussels, Belgium

8 Department of Emergency Medicine, Erasme University Hospital, Brussels, Belgium

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Annals of Intensive Care 2011, 1:49  doi:10.1186/2110-5820-1-49

Published: 24 November 2011

Abstract

Background

Hypoglycemia is associated with increased mortality in critically ill patients. The impact of hypoglycemia on resource utilization has not been investigated. The objective of this investigation was to evaluate the association of hypoglycemia, defined as a blood glucose concentration (BG) < 70 mg/dL, and intensive care unit (ICU) length of stay (LOS) in three different cohorts of critically ill patients.

Methods

This is a retrospective investigation of prospectively collected data, including patients from two large observational cohorts: 3,263 patients admitted to Stamford Hospital (ST) and 2,063 patients admitted to three institutions in The Netherlands (NL) as well as 914 patients from the GLUCONTROL trial (GL), a multicenter prospective randomized controlled trial of intensive insulin therapy.

Results

Patients with hypoglycemia were more likely to be diabetic, had higher APACHE II scores, and higher mortality than did patients without hypoglycemia. Patients with hypoglycemia had longer ICU LOS (median [interquartile range]) in ST (3.0 [1.4-7.1] vs. 1.2 [0.8-2.3] days, P < 0.0001), NL (5.2 [2.6-10.3] vs. 2.0 [1.3-3.2] days, P < 0.0001), and GL (9 [5-17] vs. 5 [3-9] days, P < 0.0001). For the entire cohort of 6,240 patients ICU LOS was 1.8 (1.0-3.3) days for those without hypoglycemia and 3.0 (1.5-6.7) days for those with a single episode of hypoglycemia (P < 0.0001). This was a consistent finding even when patients were stratified by severity of illness or survivor status. There was a strong positive correlation between the number of episodes of hypoglycemia and ICU LOS among all three cohorts.

Conclusions

This multicenter international investigation demonstrated that hypoglycemia was consistently associated with significantly higher ICU LOS in heterogeneous cohorts of critically ill patients, independently of severity of illness and survivor status. More effective methods to prevent hypoglycemia in these patients may positively impact their cost of care.

Keywords:
hypoglycemia; intensive care unit; length of stay; resource utilization; APACHE II; mortality; intensive insulin therapy