Introduction:- Stress-induced hyperglycemia (SIH) has been independently associated
with an increased risk of mortality in critically ill patients without diabetes. However,
it is also necessary to consider preexisting hyperglycemia when investigating the
relationship between SIH and mortality in patients with diabetes. We therefore
assessed whether the gap between admission glucose and A1C-derived average
glucose (ADAG) levels could be a predictor of mortality in critically ill patients with
diabetes
Objective: to assess whether stress-induced hyperglycemia, determined by the glycemic gap
between admission glucose levels and A1c-derived average glucose levels adversely affects
outcomes and icu mortality in diabetic critically ill patients admitted at Critical care department,
Benha university hospitals.
Patients and methods: the study was conducted upon 40 consecutive diabetic patients presented to
Critical care department, Benha university hospitals with sepsis andtrumatic brain injury and have SIH
during the period from July 2016 to April 2017. The glycosylated hemoglobin (HbA1c) levels were
converted to the ADAG by the equation, ADAG = [(28.7 × HbA1c) − 46.7]. The glycemic gap
was calculated from the glucose level upon ED admission minus the HbA1c-derived average
glucose (ADAG). We also used receiver operating characteristic (ROC) curves to determine
the optimal cut-off value for the glycemic gap when predicting ICU mortality and to
measure the improvement in prediction performance gained by adding the glycemic gap to
the APACHE-II score.
Results: Critically ill patients with diabetes and a glycemic gap ≥80 mg/dL had significantly
higher ICU mortality and adverse outcomes than those with a glycemic gap <80 mg/dL
(P < 0.003). Incorporation of the glycemic gap into the APACHE-II score increased the
discriminative performance for predicting ICU mortality by increasing the area under the
ROC curve from 97% to 100%..
. Conclusion: The glycemic gap can be used to assess the severity and prognosis of critically ill
patients with diabetes. The addition of the glycemic gap to the APACHE-II score significantly
improved its ability to predict ICU mortality. |
