Glycemic variability and mortality in oncologic intensive care units.
Aretha Pereira de Oliveira, Mariana da Silva Castro, Dalmo Valério Machado de Lima
PMID 37820156WHAT IT FOUND
In 30 cancer ICU patients, wider swings between highest and lowest glucose and any low glucose episode were associated with death within 28 days.
Hyperglycemia alone did not show this link.
Key findings
01In 30 cancer ICU patients, general glucose amplitude, the difference between maximum and minimum glucose values, significantly predicted 28-day mortality (p = .049), while standard deviation did not (p = .966).
02Eight patients had at least one hypoglycemia episode, six died during ICU stay, and this difference was statistically significant (p = .035).
03Hyperglycemia was not significantly associated with ICU death (p = .440), but patients with hyperglycemia were older (64.50 vs 50.30 years, p = .010) and had longer ICU stays (14.60 vs 7.20 days, p = .037).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was very small: 30 records from one oncology hospital over three months, so the findings may be unstable and cannot prove that glucose variability caused death. It was retrospective and convenience-sampled, with end-of-life care patients and still-hospitalized patients excluded, so it may not apply to all ICU cancer patients. Glucose values came from nursing records, and measurement frequency varied; capillary and arterial samples were mixed and could not be identified, which may affect accuracy. Intermittent glucose measurements may miss critical highs or lows because continuous monitoring was not used. Diabetes history was self-declared and not confirmed by laboratory tests. The significant result for glucose amplitude was p = .049 and came from a univariate analysis, so it does not show the association survived other causes.
The easy way to misread this
Do not read this as proof that controlling glucose reduces mortality. It is a small retrospective cohort of 30 cancer ICU patients, and it reports associations only: glucose amplitude predicted death within 28 days with a p-value of .049, standard deviation did not, and hyperglycemia alone was not significantly associated with ICU death (p = .440).