Accuracy of Point-of-Care Blood Glucose Level Measurements in Critically Ill Patients with Sepsis Receiving High-Dose Intravenous Vitamin C

Abstract Background: Effect of diabetes and optimal range of blood glucose level on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes affects short-term prognosis and optimal range of blood glucose level for critically ill patients.Methods: We performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database (version 1.4), collected prospectively between 2002 and 2012. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the optimal glucose range.Results: Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67-0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. The effect of the association between with diabetes and 28-day mortality was generally in line for all subgroup variables, significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction P <0.05). A V-shaped relationship was observed between glucose and 28-day mortality in patients without diabetes, with the lowest 28-day mortality corresponding to the glucose level was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl), and hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for patients with diabetes, no optimal threshold for glucose was found, and elevated blood glucose does not appear to be associated with a poor prognosis, and perhaps may be beneficial except for CCU and CSRU.Conclusions: The non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For patients without diabetes, the glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl); however, for patients with diabetes, the appropriate optimal blood glucose threshold remains unresolved.

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Effects of High-dose Intravenous Vitamin C on Point-of-Care Blood Glucose Level in Septic Patients: A Retrospective, Single-Center, Observational Case Series

10.1101/2020.11.23.20237461 ◽

2020 ◽

Author(s):

Juan He ◽

Guanhao Zheng ◽

Xian Qian ◽

Huiqiu Sheng ◽

Bing Chen ◽

...

Keyword(s):

Renal Function ◽

Blood Glucose ◽

Vitamin C ◽

Point Of Care ◽

Case Series ◽

High Dose ◽

Single Center ◽

Medical Risk ◽

Intravenous Vitamin ◽

Minimum Criteria

AbstractIntroductionHigh-dose vitamin C (hdVC) is regarded as one of the essential adjunctive drugs for sepsis treatment. The present study aimed to deduce if hdVC could lead to erroneous testing results from the point-of-care glucose (POCG) measurement.Methods and materialsThis retrospective, single-center, observational case series involved septic patients treated by hdVC and monitored their paired POCG and laboratory glucose (LG) level for statistical analysis. The Parkes Consensus Error Grid Analysis was used as clinical influence assessment for paired blood glucose values. Subgroup analyses were conducted to explore the affecting extent of POCG readings by different VC dosage and various renal function level respectively.ResultsDuring the 3-year research period, 82 eligible septic patients who accepted at least three-day hdVC treatment were included in the current study. Compliance with ISO15197:2013 criteria was met in 30 (36.59%) paired values, which was far from the minimum criteria for accuracy. Subgroup analysis showed that worse renal function or higher VC dosage could lead to greater bias of POCG reading, but clinical risk would come forth scarcely while dealing with inaccurate POCG value.ConclusionsHigh-dose intravenous ascorbate acid infusion could interfere POCG measurement values and LG method is more recommended, although significant medical risk hardly appears when physicians alter clinical action based on unreliable POCG reading.

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High-dose vitamin C infusion for the treatment of critically ill COVID-19

10.21203/rs.3.rs-52778/v1 ◽

2020 ◽

Cited By ~ 5

Author(s):

Jing Zhang ◽

Xin Rao ◽

Yiming Li ◽

Yuan Zhu ◽

Fang Liu ◽

...

Keyword(s):

Placebo Group ◽

Vitamin C ◽

Critically Ill ◽

Day Treatment ◽

Invasive Mechanical Ventilation ◽

Controlled Clinical Trial ◽

High Dose ◽

C 50 ◽

Intravenous Vitamin ◽

High Dose Vitamin

Abstract BackgroundNo specific medication has been proven effective for the treatment of patients with severe coronavirus disease 2019 (COVID-19). Here, we tested whether high-dose vitamin C infusion was effective for severe COVID-19.MethodsThis randomized, controlled clinical trial was performed at 3 hospitals in Hubei, China. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ICU were randomly assigned in as 1:1 ratio to either the high-dose intravenous vitamin C (HDIVC) or the placebo. HDIVC group received 12 g of vitamin C/50 ml every 12 hours for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way. The primary outcome was invasive mechanical ventilation-free days in 28 days(IMVFD28). Secondary outcomes were 28-day mortality, organ failure, and inflammation progression.ResultsFifty-four critical COVID-19 patients were ultimately recruited. There was no difference in IMVFD28 between two groups. During the 7-day treatment period, patients in the HDIVC group had a steady rise in the PaO2/FiO2 (day 7: 229 vs. 151 mmHg, 95% CI 33 to 122, P = 0.01). Patients with SOFA scores ≥ 3 in the HDIVC group exhibited a significant reduction in 28-day mortality (P = 0.05) in univariate survival analysis. IL-6 in the VC group was lower than that in the placebo group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P = 0.04) on day 7.ConclusionThe addition of HDIVC may provide a protective clinical effect without any adverse events in critically ill patients with COVID-19.Clinicaltrial.gov identifer: NCT04264533

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Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

Journal of Diabetes Science and Technology ◽

10.1177/1932296820964264 ◽

2020 ◽

Vol 14 (6) ◽

pp. 1065-1073

Author(s):

Archana R. Sadhu ◽

Ivan Alexander Serrano ◽

Jiaqiong Xu ◽

Tariq Nisar ◽

Jessica Lucier ◽

...

Keyword(s):

Blood Glucose ◽

Pilot Study ◽

Insulin Therapy ◽

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Point Of Care ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Target Range

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

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Glycaemic control in critical illness

10.1093/med/9780199600830.003.0259 ◽

2016 ◽

Author(s):

Simon Finfer

Keyword(s):

Blood Glucose ◽

Critically Ill ◽

Critically Ill Patients ◽

Blood Glucose Concentration ◽

Point Of Care ◽

Glucose Variability ◽

Severe Illness ◽

Loop Control ◽

Considerable Uncertainty ◽

Glucose Management

Hyperglycaemia is a near universal occurrence in critically-ill patients. In the last 10 years, control of blood glucose has been one of the most intensively studied areas of critical care medicine. It has become clear that control of blood glucose has the potential to affect both morbidity and mortality, and considerable uncertainty remains over many aspects of blood glucose management. Both hyperglycaemia and hypoglycaemia are associated with increased mortality and should be avoided wherever possible. Wide fluctuations in blood glucose concentration (referred to as increased glucose variability) are also associated with increased mortality, but may indicate more severe illness. Increased interest in blood glucose management has demonstrated that point-of-care glucose meters designed for ambulatory use by patient with diabetes are not sufficiently accurate for use in critically-ill patients. More accurate analysers should be used in the intensive care unit and management guided by computerized. Future developments may see the introduction of accurate continuous or near continuous blood glucose analysers, but safe and effective closed loop control of blood glucose remains an elusive goal.

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Fifteen-minute Frequency of Glucose Measurements and the Use of Threshold Alarms: Impact on Mitigating Dysglycemia in Critically Ill Patients

Journal of Diabetes Science and Technology ◽

10.1177/1932296819886917 ◽

2019 ◽

pp. 193229681988691 ◽

Cited By ~ 2

Author(s):

Grant V. Bochicchio ◽

Stanley A. Nasraway ◽

Laura J. Moore ◽

Anthony P. Furnary ◽

Eden A. Nohra ◽

...

Keyword(s):

Blood Glucose ◽

Critically Ill ◽

Critically Ill Patients ◽

Point Of Care ◽

Glucose Variability ◽

Clinical Team ◽

Quality And Safety ◽

Independent Group ◽

Multicenter Cohort ◽

Monitoring Devices

Background:The use of near-continuous blood glucose (BG) monitoring has the potential to improve glycemic control in critically ill patients. The MANAGE IDE trial evaluated the performance of the OptiScanner (OS) 5000 in a multicenter cohort of 200 critically ill patients.Methods:An Independent Group reviewed the BG run charts of all 200 patients and voted whether unblinded use of the OS, with alarms set at 90 and 130 to 150 mg/dL to alert the clinical team to impending hypoglycemia and hyperglycemia, respectively, would have eliminated episodes of dysglycemia: hypoglycemia, defined as a single BG <70 mg/dL; hyperglycemia, defined as >4 hours of BG >150 mg/dL; severe hyperglycemia, defined as >4 hours of BG >200 mg/dL and increased glucose variability (GV), defined as coefficient of variation (CV) >20%.Results:At least one episode of dysglycemia occurred in 103 (51.5%) of the patients, including 6 (3.0%) with hypoglycemia, 83 (41.5%) with hyperglycemia, 18 (9.0%) with severe hyperglycemia, and 40 (20.0%) with increased GV. Unblinded use of the OS with appropriate alarms would likely have averted 97.1% of the episodes of dysglycemia: hypoglycemia (100.0%), hyperglycemia (96.4%), severe hyperglycemia (100.0%), and increased GV (97.5%). Point accuracy of the OS was very similar to that of the point of care BG monitoring devices used in the trial.Conclusion:Unblinded use of the OS would have eliminated nearly every episode of dysglycemia in this cohort of critically ill patients, thereby markedly improving the quality and safety of glucose control.

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