Relative Hypoglycemia is Associated with Delirium in Critically Ill Patients with Diabetes: A Cohort Study

Figures & data

Table 1 Demographic and Baseline Clinical Characteristics of the Study Subjects

Characteristic	Total (n=113)	RHG (n=73)	Non-RHG (n=40)	P value
Age, years(range)	46 (37–55)	45 (37–53)	47.5 (39–56)	0.97
Gender, M/F	58/55	39/34	19/21	0.83
BMI	24.3(21.1–27.5)	24(20–28.3)	24.3(21–27.5)	0.88
Glycated hemoglobin	6.7(5.5–8.1)	7.5(6.9–8.7)	4.6(4.2–5.2)	0.04
APACHE II score	18(13.5–23)	18(14–23)	17(12–22)	0.77
Blood glucose level	6.4(5.5–7.3)	6.5(5.5–7.45)	6.4(5.5–7.275)	0.66
Type I diabetes	37(32.7%)	24(32.9%)	13(32.5%)	0.96
Type II diabetes	76(67.3%)	49(67.1%)	27(67.5%)	0.96
Treatment of diabetes	103(91.1%)	66(90.4%)	37(92.%)	0.71
ASA classification	3(2–4)	3(2–4)	3(2–4)	0.92
Reason for ICU admission
Emergency operative	33(29.2%)	20(27.4%)	13(32.5)	0.62
Elective operation	20(17.7%)	12(16.4%)	8(20%)	0.68
Nonoperative	60(53.1%)	41(56.1%)	19(47.5)	0.38
Comorbidities
Cardiovascular	13(11.5%)	8(10.9%)	5(12.5%)	0.84
Malignancy	11(9.7%)	7(9.6%)	4(10%)	0.97
Asthma/COPD	11(9.7%)	6(8.2%)	5(12.5%)	0.63
Chronic kidney disease	6(5.3%)	4(5.5%)	2(5%)	0.91
Chronic liver disease	5(4.4%)	4(5.5%)	1(2.5%)	0.46

Abbreviations: RHG, relative hypoglycemia; M, male; F, female; BMI, body mass index; APACHE, Acute Physiology and Chronic Health Evaluation; ASA, American Society of Anesthesiologists; ICU, intensive care unit; COPD, chronic obstructive pulmonary disease.

Table 2 Clinical Outcomes of the Study Subjects

Clinical Variables	Total (n=113)	RHG (n=73)	Non-RHG (n=40)	P value
Hospital mortality	23(20.4%)	17(23.2%)	6(15%)	0.29
28-day mortality	20(17.6%)	17(23.2%)	3(7.5%)	0.07
Hospital duration, days(range)	26(16–36.5)	21.5(15–32.25)	24(18–35.5)	0.79
ICU duration, days(range)	12(7–18)	11(6–16)	13(9–20)	0.82
MODS	27(23.9%)	19(26.0%)	8 (20.0%)	0.63
Delirium	45(39.8%)	34(47.9%)	11(27.5%)	0.04
OF at admission
Respiratory	25	14	11	0.34
Hepatic	9	6	3	0.89
Cardiovascular	11	7	4	0.94
Coagulatory	8	5	3	0.89
Renal	14	8	6	0.54
Septic shock	7	4	3	0.68
New-onset OF during ICU stay
Respiratory	10	6	4	0.75
Hepatic	6	3	3	0.44
Cardiovascular	8	5	3	0.89
Coagulatory	4	2	2	0.53
Renal	14	9	5	0.80
Septic shock	6	3	3	0.44
Requirement of organ support
RRT	28	17	11	0.62
MV	38	23	15	0.52
Vasopressor	13	7	6	0.39

Abbreviations: MODS, multiple organ dysfunction syndrome; OF, organ failure; ICU, intensive care unit; RRT, renal replacement therapy; MV, mechanical ventilation.

Figure 1 Clinical incidence of different RHG levels and their association with MODS, mortality, and delirium. *p<0.05 indicates statistical significance.

Abbreviations: RHG, relative hypoglycemia; MODS, multiple organ dysfunction syndrome.

Table 3 Risk Factors for Development of ICU Delirium in the Study Subjects

	Diabetic Critically Ill Patients
	Univariate OR (95% CI)	Multivariate OR (95% CI)
Age	1.037(1.002,1.073)	1.062(1.013,1.113)*
RHG	2.298(1.000–5.248)	3.409(1.186,9.801)*
Glucose	0.819(0.621–1.079)	0.768(0.546,1.080)
MODS	9.452(3.175–25.133)	1.905(0.147,24.649)
MV	5.288(2.276,12.290)	2.542(0.574,11.259)
RRT	6.000(2.336–15.412)	3.011(0.385,23.577)
Sepsis	0.938(0.286–3.072)	0.434(0.086,2.196)

Note: *Indicates statistical significance in multivariate analysis, p < 0.05.

Abbreviations: RHG, relative hypoglycemia; MODS, multiple organ dysfunction syndrome; MV, mechanical ventilation; RRT, renal replacement therapy.