Y XIE2, J LIN3, M GALLAGHER1, R BELLOMO4, M JARDINE1, A WANG1
1The George Institute for Global Health , Sydney, Australia, 2The Second Affiliated Hospital of Soochow University, suzhou, China, 3Beijing Friendship Hospital, Beijing, China, 4 Austin Hospital, Melbourne, Australia
Aim: To determine associations between baseline blood glucose levels (BGL) and clinical outcomes in patients with severe acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT).
Background: Uncontrolled hyperglycaemia is associated with high mortality in critically ill patients.
Methods: A secondary analysis from the RENAL study was performed. The primary endpoint was all-cause mortality at 90 days after randomization. The secondary outcomes included duration of hospital and ICU stays. The multivariate Cox regression model adjusted for baseline variables was used to assess associations of baseline BGL (measured prior to patient randomization) and mortality.
Results: Baseline BGL data were available in 1404 out of 1508 patients. The patients were divided into 4 groups using quartiles of baseline BGL (group 1, BGL <5.8mmol/L, group 2, BGL 5.8-7.2mmol/L, group 3, BGL 7.3-9.1mmol/L, and group 4, BGL>9.2mmol/L). A total of 627 patients died in 4 groups (51.7% in group 1, 38.7% in group 2, 44.5% in group 3, and 44.0% in group 4). The Cox regression model showed the baseline BGL in patients in the group 1 (<5.8 mmol/L) was associated with an increased risk of death at 90 days (HR 1.47, 95% CI 1.13–1.90, p=0.0036), compared with the group 2 (BGL 5.8-7.2mmol/L), while BGL in the group 3 and 4 did not show a significant impact on 90 days mortality. Furthermore, there were no significant differences in the duration of hospital and ICU stay among these 4 groups (p=0.55 and p=0.30, respectively).
Conclusion: Baseline BGL of less than 5.8mmol/L appears to be associated with higher mortality. This effect may be due to other unmeasured comorbidities but may warrant further study in the setting of severe AKI.
Visiting Fellow, Renal & Metabollic Division of The George Institute for Global Health